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I>RICE.  FIFTY  CEWrXS. 


ermaphrodism^ 


from  a  Medico- Legal  Point  of  View. 


! 

i 

CHICAGO;  | 

I 


W.  B.  KEEN,  GOOKE  &  CO 
1875- 

\mi^tr  ■  — ^  =  


COPYRIGHT. 
W.  B.  KEEN,  COOKE  &  CO. 

A.  D.  1875. 


HERMAPHRODISM, 

'pROM  A  ^EDICO-J^EQAL  pOINT  OF  ^\EW. 


THESIS 

Presented  to  the  Faculty  of  Medicine,  Paris,  1874, 
FOR  the  Degree  of  Doctor  of  Medicine  ; 

By  BASILS  POPPESCO. 


Translated  from  the  French, 
By  EDW.  WAEEEN  SAWYEK,  M.D.  (Harv.), 

Ijectmer  on  OlDstetrics,  Rvisli  Medical  College,  Chicago. 


CHICAGO: 

W.  B.  KEEN,  COOKE  &  CO.,  Publishers, 
Nos.  113  AND  115  State  Street. 

1875. 


V 


T  O 


JhE  ^TUDE^^TS  OF  ¥[\JSH  "jVlEDICAL  ScHOOL, 
Spring  Term,  1875, 
Who  Patiently  Listened  to  his 
FIRST  LECTURES, 
Tn[s  Little  Book  is  Respeotfully  In^scribed, 

B  Y 

The  Translator. 


NOTE 


My  motive  in  translating  this  interesting  thesis,  lias 
l^een  to  make  known  more  generally  some  additional 
and  confirmatory  facts  bearing  upon  a  rare  subject.  If 
I  (N)iild  hope  that  my  work  has  been  done  acceptably, 
my  object  is  fnlly  accomplished. 

ET)W.  WARREN  SAWYER. 

655  Cottage  Grove  Avexue, 

Cnu'Auo,  September,  1875. 


HERMAPHRODISM. 


INTRODUCTION. 

The  vices  of  conformation  of  the  genital  organs  had 
from  all  time  attracted  the  notice  of  observers  ;  but  th(^ 
absence  of  positive  knowledge  of  the  normal  anatomy 
and  pathology,  to  the  middle  of  the  eighteenth  century, 
permitted  the  ranging  of  these  facts,  which  were  much 
more  in  the  domain  of  the  marvellous  and  unknown, 
in  a  special  category,  rather  than  in  the  true  domain  of 
science. 

It  was  only  at  the  end  of  the  last  century,  and  the  begin- 
ning of  this,  that  numerous  works  appeared,  which  partly 
elucidated  the  subject  and  enabled  us  to  penetrate  the 
infinite  modifications  of  its  mechanism.  However,  it 
was  necessary  to  wait  for  the  recent  discoveries  of 
modern  anatomy,  and  the  labors  in  embryology,  in  order 
to  affirm  that  the  question  of  hermaplirodism  was  nearly 
solved. 

The  medico-legal  questions,  which  are  attached  to  this 
arrest  of  development,  can  be  treated  now  with  an  indis- 
putable competence,  before  the  tribunals  ;  because,  the 
medical  jurist  has  as  a  base  for  his  argumentation, 
and  foundation  for  his  declarations,  the  entire  group  of 
phenomena  amassed  from  embryology  and  observation. 

Prof.  Tardieu,  in  his  lectures,  and  in  his  works,  is  one 
of  those  who  have  contributed  most  to  elucidate  this 
subject,  and  to  show  all  its  practical  bearings  from  a 


8 


HERMAPIIRODISM. 


medico-legal  point  of  view.  We  have  tlioiiglit  that,  in 
the  present  state  of  science,  a  summary  of  the  principal 
c^uestions  which  belong  to  hermaphrodism  would  not  be 
deprived  of  all  interest ;  but  in  attempting  lo  overcome 
the  difficulties  of  the  subject,  we  feel  constrained  to 
beseech  of  our  judges  all  the  kindness  possible. 

HISTORY.      VARIETIES,  CLINICAL  AND  SYMPTOMATIC. 

The  origin  of  this  word  goes  back  to  the  remotest 
antiquity,  and  seems  to  be  attached  to  the  fable  of  Her- 
max)hrodite,  son  of  Mercury  ( Ep/j-r,^ )  arid  of  Yenus 
(A'<ff)orh.'zrj)^  who  remaining  insensible  to  the  charms  of 
the  nympli  Salmacis,  she  obtained  from  the  gods  the 
decree  that  her  body  might  be  united  to  his. 

Later,  the  possibility  that  an  individual  could  at  once 
possess  tlie  attributes  of  both  sexes  was  fully  admitted, 
and  already  the  Fathers  of  the  church,  Tertullien  among 
others,  were  seen  violently  opposed  to  them  ;  and  if  the 
Athenians  threw  the  reputed  hermaphrodites  into  the 
sea,  the  Romans  did  not  hesitate  to  employ  the  same 
kind  of  execution  by  precipitating  them  into  the  Tiber. 

In  the  middle  age,  ignorance  and  passion  still  follow 
these  unhappy  individuals,  disinherited  from  nature  ; 
and  we  will  be  able  to  recall,  in  this  connection,  numerous 
decrees  of  the  provincial  parliaments. 

In  tlie  rigorous  acceptation  of  the  word,  one  will 
understand  an  hermaphrodite  to  be  an  individual,  who  is 
capable  of  reproducing  one  of  his  species  without  the 
concurrence  of  another.  This  will  be,  in  the  animal 
kingdom,  an  exceptional  peculiarity,  which  will  enable 
us  to  establish  a  complete  similarity  with  that  which 
commonly  passes  in  the  greatest  number  of  vegetable 
families ;  one  class  only  in  the  vegetable  kingdom,  the 
Dia^cia,  constituting  an  exception. 

In  the  animal  kingdom,  as  one  descends  the  scale,  there 
appear  animal  hermaphrodites  ;  thus,  for  example,  among 


IIEKMAI'IIKODISM. 


9 


the  iiioUiisks,  and  the  zoophytes  ;  but  here  still  a  distinc- 
tion should  be  established  ;  although  possessing  male 
and  female  organs,  among  some  species,  (the  concha  uni- 
valvata,  for  example),  the  animal  requires,  in  order  to  be 
fecundated,  the  intervention  of  another  individual  of  his 
kind  ;  in  this  case,  the  animal  is  at  once  fecundating  and 
being  fecundated. 

On  the  contrary,  take  the  concha  bivalvata,  and  one 
will  admire  at  onc^  with  what  care  and  harmony  tlie 
laws  of  nature  have  been  established,  in  order  that  the 
fecundation  of  these  creatures,  their  unceasing  repeti- 
tion, may  not  be  interrupted  :  for  here  the  animal  has  a 
fixed  domicile,  permanent ;  it  is  impossible  for  him  to 
leave  his  roclv  ;  in  the  act  of  fecundation  he  has  no  need 
of  the  help  of  another  individual  of  his  kind  ;  he  is  at 
once  fecundating  himself  and  being  fecundated. 

I  will  not  extend  farther  these  considerations  of  com- 
parative anatom}" ;  I  only  wish  to  show  the  insensible 
gradation  that  one  meets  with  in  the  attentive  observa- 
tion of  nature ;  at  the  same  time  to  show  what  an 
immense  distance  separates  the  bisexuality  of  the  inferior 
animals  from  this,  that  has  always  been  termed  in  man, 
liermaplrrodisin  or  androgynia. 

As  M.  Tardieu  has  remarked,^'  ''the  name  of  her- 
maphrodite, under  which  one  usually  designates  these 
individuals,  is  the  worst  that  can  be  chosen,  and  gives 
the  most  false  idea  of  their  conformation/'  One  may 
say  that  it  is  not  important  which  may  be  the  predomi- 
nant sex,  the  one  or  the  other  ;  often,  even,  both  are  too 
incompletely  developed  to  be  able  to  fill  their  role  ;  the 
association  has  never,  however,  been  perfect;  it  is  scarcely 
so  in  two  or  three  recent  observations  where  the  simulta- 
neous presence  of  the  essential  and  accessory  organs  of 
the  male  and  female  sex  have  been  established  ;  I  will 
make,  however,  an  exception  in  favor  of  an  observation 

*  Question  mcdico-legale  de  riudeutitc?  dans  ses  rapports  avec  les  vices- 
de  conformation  des  organes  sexuels,  1874. 


10 


HERMAPHRODISM. 


reported  by  M.  Doumic,  ''  quoted  by  Dr.  Heppner,  of  St. 
Petersburg,  also  for  two  other  observations  which  are 
found  at  the  end  of  this  thesis  ;  one  taken  from  the 
Journal  Lo  Sperimeritale  of  Florence  (1874),  the  other 
from  the  Lyon  Medical  same  year. 

Haller,  f  relying  on  the  considerations  of  structure, 
had  already  said,  that  the  union  of  the  two  sexes  was 
absolutely  irreconcilable  with  the  conformation  of  the 
pelvis;  and  later,  Meckel,  and  Serres  especially,  really 
<'orroborate  this  opinion  in  taking  for  the  base  of  their 
refutation  the  law,  called  by  the  latter,  the  law  of  the 
equilibrium  of  the  organs. 

In  the  last  century,  the  authors  were  divided  into  two 
parties,  regarding  the .  sex  of  the  presumed  hermaphro- 
dites :  one,  with  Osiander,  thought  that  they  were  nearly 
all  males,  w^liile  Parsons^  and  Hill,  on  the  contrary, 
supposed  them  nearly  all  females. 

To-day,  the  almost  unanimous  opinion  is,  that  in  the 
great  majority  of  cases  that  are  wrongly  called  her- 
maphrodites, they  are  individuals  of  the  male  sex  in 
whom  the  testicles  have  descended  and  are  atrophied,  or 
rather,  on  the  contrary,  remain  included  within  the  cavity 
of  the  abdomen  ;  in  whom  a  i)enis  is  recognized,  having  an 
incomplete  development ;  a  urethra  more  or  less  opened 
at  the  base  of  the  penis  ;  tinally,  a  failure  in  union  of  the 
•  two  latei  al  ])arts  which  had  as  their  special  destination, 
on  account  of  their  approaching  each  other  and  their 
intimate  adherence,  the  forming  of  the  superficial  cov- 
erings of  the  pouches,  the  scrotum,  strictly  speaking. 
In  a  word,  the  arrest  of  development  which  constitutes, 
strictly,  hermaphrodism,  consists  essentially  in  two 
si)ecial  alterations  of  the  external  and  internal  genital 
organs,  which  have  been  designated  under  the  name  of 
hypospadias  and  cryptorchidia ;  as  M.  Tardieu  does 

*  Doumic,  Gazette  Med.,  Paris,  1872. 
\  Comm.  Soc.  R.  Gott.,  t.  1,  pi.  1. 

X  Parsons'  Medical  and  Critical  Inquiry  into  ihe  Nature  of  Hermaph- 
rodites.   London,  1741. 


IIEKMAPHRODISM. 


11 


not  hesitate  to  say.  "that  one  will  not  be  in  doubt  that 
these  are  malformed  men,  but  men/'  The  same  opinion 
is  equally  supported  b\^  M.  Legrand  du  SauUe  in  his 
Treatise  of  Legal  Medicine  (187^). 

Nevertheless,  though  the  arrest  of  development  in  the 
male  sex  constitutes  the  greatest  part  of  the  facts  in 
science  under  the  name  of  hermaphrodism,  we  will  de- 
scribe, after  the  authors,  the  three  most  important  varie- 
ties :  we  believe  this  division  necessary,  not  only  because 
we  will  be  enabled  better  to  group  the  facts,  but  because 
it  accords  with  the  observation  and  with  the  minute  de- 
scription given  by  Is.  Gfeoffroy  Saint  Hiliare,  Dutrochet 
and  Marc.^ 

I.     APPAKEXT  HERMAPHRODISM  IX  THE  MALE  SEX. 

Sometimes  the  arrest  of  development  involves  only  the 
generative  organs,  sometimes  there  are  phenomena  worthy 
of  being  spoken  of  which  belong  to  the  general  conlign- 
ration  of  the  individual.  We  will  tirst  describe  the 
former,  or  phenomena  localized  in  the  generative  sphere, 
properly  speaking. 

The  penis  offers,  usnally.  an  incomplete  development  : 
its  length  is  more  or  less  reduced  ;  it  is  formed  by  the 
union,  the  fusion  of  the  two  corpora  cavernosa  ;  the 
glans  is  often  malformed  ;  moreover,  if  it  exists  it  re- 
mains uncovered,  in  consequence  of  the  absence,  or  the 
want  in  length,  of  the  prepuce.  One  will  readily  admit 
that,  if  the  volume  of  this  organ  is  very  slight,  not  ex- 
ceeding in  length  two-thirds  of  an  inch  or  an  inch,  it 
may  sometimes  be  difficult  to  distinguish  it  from  the  cli- 
toris, if  besides  there  are  added  to  this  other  vices  of  con- 
formation. This  penis  is  capable  of  an  erection,  and  the 
intromission  of  the  organ  will  depend  directly  upon  the 
length  which  it  can  acquire  at  the  moment  of  venereal 
spasm. 

*  Diet,  en  30  ;  Art.  Hermaphrodisme. 


12 


HERMAPHRODISM. 


Below  this  penis,  one  recognizes  a  deformity  also  very 
important  ;  we  allude  to  that  arrest  of  development 
which  has  received  the  name  of  hypospadias.  There  are 
a  number  of  varieties  of  this  ;  sometimes  the  urethra  is 
o])ened  at  a  point  very  nearly  approaching  the  terminal 
♦^xlremity  of  the  penis,  and  then  it  is  not  a  true  her- 
niai)hrodism ;  sometimes,  on  the  contrary,  it  is  only 
towards  the  middle  of  the  penis  that  a  canal  is  observed 
which  0])ens  directly  into  the  bladder ;  finally,  the  most 
irequent  variety  is  that,  in  which  an  opening  is  found 
quite  at  the  base  of  the  organ,  the  orifice  of  w  hich  is  just 
beneath  tlie  pubis,  in  an  infundibuliform  cavity  w^hich 
we  will  describe  presently. 

In  tliis  case,  one  observes  also  the  co- existence  of  other 
arrests  of  development.  We  know  that  the  scrotum  is 
the  result  of  the  intimate  union  of  the  two  lateral  folds, 
which  unite  in  the  median  line  and  form  a  well  marked 
raphe,  that  corresponds  superiorly  to  what  is  known 
under  the  name  of  the  septum  of  the  dartos.  When 
this  union  of  these  lateral  folds  does  not  take  place, 
and  these  two  external  processes  from  the  blastoderm 
remain  separated,  there  will  result  an  absence  of  the 
scrotum,  and  each  side  will  have  the  gross  appearance 
of  the  labium  majus. 

Tliese  two  separated  parts  leave  on  the  median  line  a 
fissure,  which  extends  from  before  backwards ;  some- 
times this  is  very  superficial,  sometimes,  on  the  contrary, 
it  is  a  true  liollow^  cavity,  more  or  less  funnel  shaped. 
This  cavity  does  not  extend  very  far  forward,  the  finger 
is  soon  arrested,  and  at  the  anterior  and  superior  ]mrt 
one  can  recognize  the  abnormal  opening  of  the  urethra. 
If  it  is  wished  to  carry  the  examination  farther,  the 
catheter  may  be  introduced  nearly  into  the  bladder  and 
the  finger  into  this  abnormal  cavity,  when  the  presence 
of  the  prostate,  and  even  the  vesicul^e  serainales,  will  be 
demonstrated  ;  most  frequently,  however,  it  will  be  nearly 
impossible  to  arrive  at  such  precision  in  the  diagnosis. 


HERMAPHRODISM. 


13 


the  cavity  being  too  shallow  and  the  rectal  touch  giving 
but  very  uncertain  information. 

But  a  fact  which  leads  still  more  to  the  confounding  of 
the  external  conformation  of  these  subjects  with  the 
special  conformation  of  the  female  sex,  is  the  absence  of 
the  testicles,  or,  at  least,  their  permanent  inclusion  within 
the  abdominal  cavity.  It  w^ill  be  understood  how  neces- 
sary it  is  in  these  cases  to  practice  a  delicate  palpation  : 
because,  the  absence  or  presence  of  these  organs  indi- 
cates more  exactly,  for  the  medical  jurist,  and  for  the 
expert,  the  course  which  he  will  follow  in  the  decision 
which  is  necessary  for  the  proper  ranking  of  this  indi- 
vidual in  the  civil  state  ;  or  the  motives  which  he  can 
allege  in  favor  of  a  rupture  of  the  marriage. 

'Not  only  the  lateral  pouches  which  represent  the  scro- 
tum ought  to  be  examined,  but  the  inguinal  ring  and  the 
entire  inguinal  tract  should  be  explored  ;  because,  it  is 
not  exceptional  to  find,  in  those  cases  of  presumed  her- 
maphrodites, the  testicles  retained  within  the  inguinal 
canal,  from  which  their  descent  does  not  take  place 
till  the  epoch  of  puberty.    Finally,  one  should  recall  the 

interesting  case  of  Alexina  B  ,  reported  by  Prof. 

Tardieu,  in  whom  the  testicles  were  retained  within 
the  inguinal  canal,  and  were  the  seat  of  a  most  violent 
congestion  at  the  time  of  puberty,  which  was,  for  the 
physician,  the  first  indication  of  a  vice  in  conformation 
presented  by  this  presumed  young  girl. 

Moreover,  in  the  variety  of  hermaphrodism  with 
w^hich  we  are  occupied  at  present,  the  most  frequently 
observed,  one  can  say  that  the  principal  characteristics 
are  comprised  in  the  following  observations :  diminution  in 
the  size  of  the  penis ;  hypospadias,  generally  well  marked : 
absence  of  union  of  the  two  lateral  parts  whicli  normally 
go  to  form  the  scrotum  ;  and  finally,  cryptorcliidia. 

To  these  local  signs  of  hermaphrodism,  may  be  added 
a  series  of  phenomena  which  belong  to  the  general  con- 
formation of  the  individual ;  and  often,  too,  not  only  are 


14 


iiERMAPirRODis:\r. 


the  external  pliysical  characteristics  similar  to  the  female 
exterior,  but  the  real  character,  the  habits,  the  passions, 
conform  to  the  female  sex  rather  than  to  the  male. 

The  stature  is  generally  medium  ;  the  rotundity  of 
body  (r  emboni:>oint)  is  considerable  ;  the  skin  is  smooth 
and  fine,  deprived  of  hair  upon  the  face  as  well  as 
upon  the  trunk  ;  the  muscular  system  is  slightly  de- 
veloped, or  rather  it  is  marked  by  a  full  adipose  devel- 
opment ;  the  muscular  projections  and  the  bony  ridges 
are  effaced  ;  the  extremities,  in  a  word,  like  the  face,  have 
the  appearance  of  the  feminine  type ;  the  voice  even 
has  a  high  pitch,  and  is  feeble  ;  the  pelvis  is  sufficiently 
developed,  and  the  ilia  project  outwards  ;  there  is  even 
an  abnonual  turning  outwards  of  the  ischio-pubic 
branches  ;  and  the  breasts  are  of  considerable  size.  These 
individuals  prefer  sedentary  occupations  ;  tliey  like  gar- 
ments of  brilliant  colors  ;  are  excessively  coquettish  and 
adore  perfumes  ;  an  oriental  extravagance  reigns  in  their 
apartments  (obs.  iv) ;  they  are  also  passionately  fond  of 
needle-work,  etc.  ;  in  a  word,  everything  in  the  outward 
character  contributes  in  keeping  up  the  error  as  to  the 
real  sex  of  these  individuals. 

At  the  end  of  this  essay,  several  observations  can  be 
seen  which  relate  clearly  to  this  form  of  liermaphrodism, 
therefore  I  will  not  stop  to  detail  those  examples,  which 
are  classical  to-day,  of  Marie  Marguerite,  of  Dreux,  re- 
lated by  Worbes,  which  is  found  in  the  journal  of  Hufe- 
land.  To  this  same  variety  belongs  equally  the  case  of 
Justine,  A.  J.,  which  was  decided  by  the  civil  tribunal  of 
Alais  (1869),  then  by  the  courts  of  Montpelier  (1872),  and 
of  Nimes,  after  the  first  decision  had  been  reversed  by 
the  Court  of  Cassation  (1869).  In  the  last  place  it  was 
finally  brought  back  before  the  civil  tribunal  of  Alais 
(1873),  the  court  then  declared  the  individual  "  absolutely 
nothing:,  a  nonentity,  and  annulled  the  marriage  inscribed 
upon  the  registers  of  the  civil  state,  and  consequently, 
the  ante-nuptial  pledge,  which  governed  the  agreements 


HERMAPIIKODISM. 


15 


of  the  parties  ;  and  ordered  that  mention  of  the  present 
decision  be  made  on  the  maro-in  of  the  act  of  celebration 
of  the  aforesaid  marriage,  thus  annulled  by  the  officer 
of  the  civil  state  of  the  said  commonwealth  of  Alais." 

II.     APPARENT  ITEPvMA.PIIKODISM  IN  THE  FEMALE  SEX. 

It  is  much  more  rare,  as  we  have  already  said,  to  en- 
counter in  the  female  a  disposition  of  the  sexual  organs 
such  as  could  lead  one  in  error  as  to  their  true  sex,  and 
consequentl3%  such  as  would  lead  us  to  suppose  that 
we  had  to  do  with  an  individual  of  the  male  sex. 
Nevertheless,  several  such  cases  exist  in  science,  and 
these  are,  in  summary,  the  peculiarities  presented  to  the 
observer.  The  vagina  is  reduced  to  a  simple  funnel- 
shaped  hollow  cavity  ;  it  is  imperforate,  or  narrowed  by 
bridles,  which  are  so  numerous  that  it  is  impossible  to 
find  the  neck  of  the  uterus  b}^  the  touch  ;  the  organ 
cannot  be  reached  other  than  by  a  methodical  palpation, 
or  by  the  simultaneous  employment  of  the  catheter  and 
the  rectal  touch.  The  clitoris  may  be  as  voluminous  as 
in  the  case  of  the  hypospadias  which  we  have  related 
above ;  finally,  singularly  coincident,  the  meatus  urina- 
rius,  in  consequence  of  an  unusual  elongation  of  the 
urethra,  may  be  found  just  beneath  the  clitoris,  which 
fact  increases  the  chance  of  error,  when  only  a  simple 
superficial  examination  is  made.  The  labia  majora,  in 
these  cases,  are  but  slightly  pronounced ;  often  the 
nymplise  are  scarcely  marked,  in  consequence  of  an 
arrest  of  development  in  all  the  parts  ;  finally,  a  last 
fact,  which  is  prominent  in  some  instances,  and  which 
still  more  singularly  obscures  the  diagnosis,  is  the 
presence  of  the  ovaries  in  the  substance  of  the  labia 
majora,  in  consequence  of  an  inguinal  hernia.  It  is 
then  that  only  a  most  carefully  conducted  examination 
will  enable  us  to  differentiate  the  testicles  from  the 
ovaries  {Estopie  OTarlenne.  Lonmaigne.  these  inaugurale 


16 


HERMAPHKODISM. 


1869).  But,  we  repeat  it,  this  variety  is  rare — really  ex- 
ceptional. In  the  great  majority  of  the  cases,  it  will  be 
easy  enough  to  establish  this  variety  of  hermaphrodism, 
which  consists  really  and  simply  in  an  arrest  of  develop- 
ment, in  a  default  of  communication  between  the  external 
and  internal  genital  parts.  It  is  true  that,  in  these  cases, 
the  ovaries^  the  sign  par  excellence  of  the  female  sex, 
exist — sometimes  displaced,  sometimes  in  their  normal 
situation — and  indicate  their  presence,  not  by  the  menses, 
which  cannot  ajjpear,  but  by  various  periodical  troubles, 
symptoms  of  congestion,  increased  secretions,  haemor- 
rhages, etc.,  which  resemble  really  the  regular  menstrual 
evolution. 

Add  to  these  local  signs,  the  entire  group  of  external 
physical  characteristics,  and  intellectual  manifestations, 
which  are  really  more  conformed  to  the  male  sex  than  to 
the  female,  and  it  will  be  seen  that  it  is  with  reason  that 
the  writers  of  the  last  cantury,  and  the  beginning  of  this, 
have  insisted  with  so  much  detail  upon  these  analogous 
facts.  The  general  complexion  of  these  persons  is  much 
more  masculine  ;  the  stature  is  increased,  the  body  is  lank, 
the  limbs  powerful ;  the  muscular  projections  and  the 
bony  ridges  are  well  pronounced  ;  the  hair  is  short,  the 
hair  follicles  are  developed  and  the  surface  of  the  body 
is  covered  with  hair ;  the  breasts  are  slightly  developed  ; 
the  depth  of  the  pelvis  is  increased,  and  the  menstruation 
is  more  or  less  completely  wanting  Add  to  all  this, 
the  aptitude  for  a  series  of  manly  tastes,  a  preference  for 
the  occupations  which  require  force  and  vigor,  a  deep 
voice,  and  you  will  have  under  your  eyes,  in  a  few  words, 
those  creatures  which  the  Romans  designated,  with  just 
reason,  under  the  name  of  virago.  One  feature  alone 
which  led  to  error  in  several  of  the  cases  cited  was,  that 
the  clitoris  was  so  long  that  it  was  capable  of  copulation  ; 
but,  as  M.  Tardieu  has  said,^  "this  fact  alone  does  not 
change  tlie  conditions  upon  which  are  founded  the  dis- 
tinction of  the  sexes." 

Tardieu,  loc.  cit. 


IIERMAPHRODISM. 


17 


Marie  Madeleine  Lefort,  said  Beclord,^'  seemed  to  be- 
long to  the  male  sex,  if  one  considered  the  size  of  the 
trunk  and  the  extremities,  the  shoulders  and  the  pelvis, 
the  size  of  the  larynx,  the  tone  of  the  voice,  the  develop- 
ment of  the  beard,  and  the  urethra  prolonged  beyond  the 
symphysis  pubis.  But  she  possessed,  at  the  same  time, 
the  essential  and  constitutive  organs  of  woman,  uterus 
and  vagina.  Below,  and  posteriorly  to  the  peniform 
clitoris,  was  a  fissure  or  vulva  bordered  by  two  narrow, 
short  labia,  which  were  united  by  a  thick  and  dense 
membrane.  At  the  foot  of  the  clitoris,  this  membrane 
w^as  perforated  with  a  round  opening  which  gave  passage 
to  the  urine  and  the  menstrual  discharge,  and  would 
have  been  sufficient,  without  doubt,  to  have  made  the 
vagina  accessible  if  an  incision  had  been  made,  between 
these  two  labia,  from  the  base  of  the  clitoris  nearl}'  to  the 
posterior  commissure.  Since  this  instance,  analogous 
cases  have  been  reported  by  MM.  Bouilland  and  Manec, 
Briquet,  Richard,  Gallard  and  Lefort.  f 

Marc,  in  his  article  of  the  Diet,  en  30,  reports  that  a 
uterus  fallen  out  of  the  vagina  has  sometimes  led  the 
inattentive  and  ignorant  surgeons  in  error,  who  believed 
it  to  be  a  veritable  penis.  Such  was  the  mistake  of  the 
surgeons  and  the  chief  magistrates  of  Toulouse  respect- 
ing a  woman  whom  they  declared  an  hermaphrodite,  in 
1693,  and  ordered  her  to  wear  the  clothing  of  males. 
This  woman  coming  to  Paris,  was  subjected  to  an  exami- 
nation by  able  men  ;  Saviard  alone  recognizing  the  error, 
reduced  the  prolapsed  uterus,  and  gave  to  this  woman 
her  true  sex. 

Everard  Home  (Philos.  Trans.,  1799,)  cites  a  similar 
case. 

It  seems  to  me  sufficient  to  prevent  falling  into  a  like 
error,  to  know  that  it  may  be  committed. 

*  Bulletin  de  la  Socicte  de  la  Faculte  de  Medicine,  1815. 
f  Lefort,  Th^se  d'Agrtigation,  1863.    Des  vices  de  Conformation  de 
'uterus  et  du  Vagin. 
2 


18 


HEEMAPHKODISM. 


III.     NEUTER  HEEMAPHKODISM. 

A  third  variety  of  hermaphrodism  is  that  which  is 
designated  under  the  name  of  neuter  hermaphrodism  ; 
it  has  been  attempted  to  include  in  this  variety  two  differ- 
ent categories  :  1,  the  persons  whose  sex  is  not  easily 
determined,  well  pronounced  ;  2,  those  persons  in  whom 
is  observed  the  simultaneous  existence  of  the  organs  of 
both  sexes  ;  this  variety  is  also  called  the  bisexual 
hermaphrodism. 

The  first  variety  dDes  not  exist  ;  there  are  no  beings 
absolutely  neuter,  not  having  one  sexual  attribute  ;  and 
nearly  all  the  cases  reputed  to  be  such,  should  be  included 
in  the  apparent  hermaphrodism  of  the  male  sex.  Such 
is,  at  least,  the  opinion  of  the  medical  jurist,  and  it  is 
certain  that  one  should  adopt  in  consultations  that 
wliich  is  demanded  of  him  in  law. 

Prof.  Tardieu  does  not  admit  a  single  authenti- 
cated instance  of  bisexual  hermaphrodism,  with  coexist- 
ence of  all  the  essential  and  accessory  organs  of  the 
male  and  female  sex.  The  fact  has  been  admitted,  how- 
ever, by  such  authors  as  Maret,  Meckel,  Duges,  Is. 
Oeoflfi'oy  Saint-Hilaire,  Dutrochet;  but  it  is  true  that,  at 
this  epoch,  they  were  limited  to  an  anatomical  examina- 
tion of  the  organs.  We  will  make  known  our  observa- 
tions, however,  in  wiiich  the  histological  examination 
having  been  made  by  competent  men,  the  simultaneous 
existence  of  the  ovaries  and  testicles  was  established 
beyond  question. 

Maret'^  reported  an  instance  of  the  simultaneous  exist- 
ence of  the  organs  of  both  sexes  ;  on  one  side,  said  he, 
the  labium  contained  a  veritable  testicle,  with  the  cord  of 
the  spermatic  vessels,  the  vas  deferens,  and  a  seminal 
vesicle  full  of  spermatic  fluid.  The  right  labium  en- 
closed a  membranous  pouch,  in  wliich  descended,  when 
the  abdomen  was  compressed  with  the  hand  in  the  right 


*  Maret  M6m.  de  I'Acad.  de  Dijon  :  Vesiculas  seminaleset  ovarium  habens. 


HERMAPHRODISM. 


19 


iliac  region,  an  ovoidal  body,  wliicli  was  recognized  as  an 
uterus,  without  any  communication  with  the  external 
parts,  but  having  one  Fallopian  tube  and  one  ovary. 
"Hubert,"  says  this  author,  "though  he  had  the  es- 
sential organs  of  both  sexes,  was  not  able  to  fill  the  func- 
tions of  either  ;  in  vain  did  the  testicle  elaborate  the 
semen  when  an  imperforation  of  the  penis  opposed  its 
emission ;  a  Fallopian  tube  embraced  in  vain  a  well 
formed  ovary,  when  the  uterus  was  enclosed  in  a  pouch 
without  opening." 

This  singular  variety,  in  which  the  individual  is  found 
on  one  side  of  the  body  constructed  after  the  type  of  the 
male  sex,  and  on  the  other  after  that  of  the  female  sex,  has 
been  described  by  Is.  Geoffroy  Saint-Hilaire, under  the 
name  of  hermaphrodism  with  excess  in  the  number  of 
parts,  liermaplirodlsm  bisexual  or  lateral.  Yerdier  and 
Sou  have  met  with  an  analogous  instance,  as  have  also 
Colombo  and  Petit ;  these  cases  will  be  rather  of  the 
type  that  should  be  known  under  the  name  of  androgy- 
nia  ;  but  the  most  commonly  then,  the  arrest  of  develop- 
ment, especially  in  the  case  where  the  sexual  system  is 
double,  belongs  sometimes  to  the  sphere  of  the  masculine 
organs,  sometimes  to  the  feminine  organs,  in  virtue  of  the 
law  discovered  by  Serres,  which  he  designated  under  the 
name  of  the  equilibrium  of  the  organs. 

But,  we  repeat  it,  these  varieties  of  hermaphrodism 
are  more  than  exceptional  ;  and  we  have  enlarged  upon 
them  because  of  the  scientific  standing  of  the  men  who 
have  called  attention  to  them.  Without  the  aid  of  the 
microscope,  it  appears  to  us  very  difficult  to  distinguish 
between  an  ovary  and  a  testicle,  especially  when  con- 
cerned with  organs  that  are  atrophied,  compressed,  and 
have  lost  not  only  their  normal  relations  but  all  their 
external  features  and  their  distinctive  microscopical 
characteristics.    Our  aim  has  been  only  to  represent  the 

*  Is.  Geoffroy  Saint-Hilaire.  Recherches  anat.  et  phys.  sur  rhermaphro- 
dism  chez  rkomme  et  les  aaimaux  ;  rapport  de  Dutrochet. 


20 


HEEMAPHEODISM. 


ideas  and  the  opinioris  sustained  and  learnedly  elabor- 
ated by  those  who  have  preceded  us. 

In  closing,  I  will  name  one  other  variety,  designated 
und;  r  the  name  of  superadded  hermaphrodism,  by 
Dutrochet :  in  this  case,  the  deepest  organs  are  of  one  sex, 
the  medium  organs  are  of  the  opposite  sex,  and  the 
external  organs  are  the  association  of  both  sexes. 

From  what  precedes,  we  are  able  to  conclude,  in  a 
medico-legal  point  of  view,  that  hermaphrodism  presents 
itself  to  the  observer  under  two  principal  forms ;  the 
frequent  one,  is  that  in  which  an  individual  of  the  male 
sex  offers  an  arrest  of  development,  with  some  general 
and  local  features  which  approach  the  female  sex  ;  the 
other,  rare  and  exceptional,  in  wliich  the  person  of  the 
female  sex  has,  simultaneously,  an  excess  of  develop- 
ment in  one  organ  and  an  arrest  of  development  in 
some  others,  with  a  predominance  of  the  masculine  con- 
formation more  or  less  marked. 

EMBRYOLOGY  AND  PATHOLOGICAL  PHYSIOLOGY. 

The  preceding  study  would  certainly  remain  in  a  state 
of  confusion  and  be  vaguely  remembered  if,  in  reviewing 
the  facts,  we  could  not  at  tirst  sight  with  clearness  and 
precision  refer  all  these  infinite  varieties  to  an  arrest  of 
development :  thanks  to  the  works  of  modern  embry- 
ology. The  names  of  Isidore  Geoffroy  Saint-Hilaire, 
Dutrochet,  Serres,  and  of  Coste,  recall  the  authors  who 
have  best  elucidated  these  questions. 

The  genital  organs  consist  essentially  of  two  classes, 
which  are  clearly  distinct,  both  in  the  man  and  in  the 
woman  :  those  of  the  one,  preponderant  and  essential,  are 
developed  within  the  abdominal  cavity,  and  are  especially 
designed  for  the  secretion  of  the  fundamental  products, 
ovule,  sperm  ;  the  other,  secondary  and  accessorj^-,  per- 
form their  functions  outside  of  the  abdominal  cavity,  in 
the  neighborhood  of  the  pubic  arch.  These  two  parts  dur- 
ing intra-uterine  life  are  independent  of  each  other.  They 


HERMAPHRODISM. 


21 


have  a  different  location,  their  vessels  and  nerves  arise 
from  opposite  sources,  and  tliey  are  even  separated  from 
each  other  by  structures,  whose  normal  role  is  to  disap- 
pear at  a  given  moment  of  foetal  evolution.  When  this 
disappearance  does  not  take  place,  and  the  adhesion 
abnormall}^  persists,  there  will  result  some  variety  of 
these  arrests  of  development  which  we  Lave  designated 
under  the  name  of  hermaphrodism. 

Take,  for  example,  the  conformation  of  the  female 
sexual  apparatus ;  one  of  the  two  groups  of  organs  is 
superficial  and  comprises  the  external  genital  organs  ;  the 
other  is  profound,  intra-pelvic,  and  comprises  the  organs 
of  generation,  properl}^  speaking,  or  the  internal  genital 
organs;  these  two  groups  are  connected  by  an  intermediate 
organ,  the  vagina,  interposed  between  the  has-fond  of  the 
bladder  anteriorly  and  the  rectum  posteriorly,  in  such  a 
manner  that  it  is  a  mixed  organ,  having  a  particular  devel- 
opment, a  special  formation  :  should  this  conduit  become 
obliterated,  and  the  internal  genital  organs  become  atro- 
phied, then  the  external  genital  parts  present  an  exagger- 
ated development,  and  there  will  result  that  variety  of 
hermaphrodism  which  is  usually  designated  under  the 
name  of  apparent  hermaphrodism  in  the  female  sex  ; 
because,  then,  the  clitoris  acquires  an  exaggerated  size,  it 
is  grooved,  as  in  those  individuals  who  are  the  subjects  of 
hypospadias,  and  the  meatus,  also,  opens  almost  at  the 
base  of  the  clitoris. 

But  the  results  of  embryology  will  enable  us  to  pene- 
trate still  further  in  the  study  of  these  facts.  In  an  em- 
bryo of  thirty-five  days,  the  Wolffian  bodies,  situated  on 
the  sides  of  the  vertebral  column,  are  completely 
developed :  on  their  external  face,  there  is  a  distorted 
conduit,  which  terminates  above  in  a  wide  orifice:  in- 
feriorly,  it  opens  in  the  bladder,  alongside  of  that  of  the 
opposite  side;  it  is  this  conduit,  called  the  sperm  duct  or 
oviduct,  which,  later,  will  constitute  the  vas  deferens  or 
Fallopian  tube^  according  to  the  sex.    On  the  internal 


22 


HERMAPHEODISM. 


surface  of  the  same  Wolffian  bodies,  is  observed  a  swelling, 
which  grows  from  day  to  day  :  this  will  be  the  testicle  or 
ovary ;  this  swelling  has  two  filamentous  processes,  the 
superior  of  which  goes  to  be  attached  to  the  oviduct,  the 
inferior  goes  to  be  inserted  in  the  pubic  spine.  Later,  if 
the  individual  is  of  the  male  sex,  the  spermduct  goes  to 
unite  with  the  testicle,  then  the  vas  deferens  exists ;  on 
the  contrary,  if  the  person  is  of  the  female  sex,  the- 
Fallopian  tube  remains  isolated  from  the  ovary. 

Inferiorly,  the  oviduct  and  the  spermduct  are  arranged 
in  two  different  ways  ;  the  spermduct  remains  separated 
from  its  fellow,  and,  after  traversing  an  enlargement,  which 
will  become  the  prostate,  opens  into  the  inferior  part  of 
the  urinary  passages.  The  prostate,  which,  according  to 
some  authors,  (Meckel,  Is.  Geoffroy  Saint- Hilaire,)  ought 
especially  to  be  regarded  as  the  analogue  of  the  uterus, 
is  a  structure  formed  by  the  two  vasa  deferentia,  just  as- 
will  be  seen  the  uterus  is  manifestly  a  formation  of  the^ 
two  oviducts.  In  reality,  these  two  conduits  unite  ta 
form  a  single  cavity  which  will  be  the  cavity  of  the 
uterus;  should  the  fusion  be  incomplete,  there  will 
result  a  vice  of  conformation  very  rare,  a  partitioned 
uterus  ;  of  which  a  remarkable  specimen  is  in  the  museum 
of  Orfila. 

The  preceding  observations  arise  from  the  facts  already 
prominently  advanced  by  Dutrochet,  in  his  report  on  the 
memoir  of  Is.  Geoffroy  Saint-Hilaire,  viz.,  the  complete 
analogy,  the  absolute  identity  which  exists  in  the  sphere 
of  the  internal  generative  organs  during  the  first  months 
of  intra-uterine  life,  in  the  blastema  even  ;  in  the  primi- 
tive seat,  the  absolute  identity  which  exists  in  the 
internal  part  of  the  Wolffian  bodies  ;  the  analogous  struc- 
ture of  the  conduits  which  constitute  the  Fallopian  tube 
or  the  vas  deferens  ;  even  the  anatomical  elements  enter- 
ing into  the  structure  of  that  which  will  some  day  be  the 
ovary  or  testicle,  the  uterus  or  the  prostate.  It  is  not 
until  the  eighth  month  that  the  testicles  leave  the  places- 


HERMAPHRODISM. 


23 


which  they  occupied,  and  during  the  ninth  month  they 
traverse  the  inguinal  canal,  in  order  to  reach  the  scrotum. 
This  remarkable  analogy  is  even  more  striking,  when  we 
come  to  consider  the  development  of  the  external  gener- 
ative organs.  It  is  at  about  the  sixth  week  that  there  is 
seen  to  form,  from  the  animal  layer,  or  the  external 
layer  of  the  blastodermic  membrane,  a  fissure  which  is 
common  to  the  genito-urinary  organs  and  the  apparatus 
of  defecation,  and  which  has  received  the  name  of 
cloaca;  this  fissure  will  always  extend  to  meet  the 
cul-de-sac  formed  by  the  inferior  extremity  of  the  intes- 
tinal layer.  From  each  side  of  this  antero-posterior 
fissure,  according  to  Coste,  two  projections  appear  supe- 
riorly :  rudimentary  corpora  cavernosa  ;  interiorly,  there 
are  two  other  smaller  projections,  which,  in  the  man, 
are  the  origin  of  the  scrotum,  and  in  the  woman,  of  the 
labia  majora.  These  two  upper  processes  unite  at  their 
upper  surface,  leaving,  on  their  inferior  surface,  a  groove 
for  the  canal  of  the  urethra,'  in  the  male,  while  in  the 
female,  the  groove  remains  permanent.  If,  in  the  male, 
the  urethral  canal  fails  to  be  developed  beneath  the 
corpora  cavernosa,  which  constitute  the  penis,  there  will 
result  a  vice  of  conformation  which  we  have  already 
spoken  of  as  hypospadias.  The  two  inferior  processes 
remain  distinct  from  each  other;  but  we  may  know,  at 
the  same  time,  as  Professor  Hichet  has  said,  "  whatever 
the  future  sex  may  be,  no  difference  exists  ;  and  it  is  not 
till  later,  in  uniting,  that  the  two  processes  form  the 
scrotum  in  the  male,  while  in  the  female,  separated  by 
the  longitudinal  fissure,  they  form  the  labia  majora." 

Later,  a  septum  divides  into  two  portions  the  fissure, 
which,  to  this  time,  was  designated  under  tlie  name 
of  cloaca  ;  the  anterior  division  of  this  fissure,  (uro-geni- 
tal)  continues  to  be  a  cavity,  into  which  the  excretory 
canals  of  the  genital  and  urinary  organs  open. 

Finally,  in  the  male,  the  union  of  the  two  lateral  pro- 

*  Richet.    Trait6  d'  Anat.  M^d-Chirurg. 


24 


IIEKMAPIIRODISIM. 


cesses  takes  place,  while  in  the  female,  the  persistent 
labia  continue  to  limit  an  opening,  which  now  takes  the 
name  of  vulva. 

Thus,  from  this  observation,  we  learn  that,  in  the  first 
moments  of  their  existence,  the  external  genital  organs 
of  all  fa^tuses  have  the  same  conformation,  to  that  degree, 
even,  that  the  clitoris  in  the  fcptus  of  four  months  is  as 
large  as  the  penis  of  the  foetus  of  tlie  same  age.  Two 
phases  in  the  development,  are  tlien  observed  :  in  the 
first,  the  separation  of  the  two  lateral  parts,  which  to  this 
time  had  developed  towards  each  other,"  remains  perma- 
nent ;  whilst  in  the  second  phase,  and  only  in  the  male 
foetus,  the  union  of  the  two  lateral  parts  is  effected  ; 
in  this  connection,  we  repeat  tlie  judicious  remark  of 
Dutrochet  "  With  respect  to  the  conformation  of  the 
external  genital  organs,  every  man  was  at  first  a  woman." 

Should  the  two  borders  of  the  uro-genital  fissure  fail 
to  approach  each  other,  there  will  be  beneath  the  penis, 
often  of  diminished  size,  an  infundibuliform  cavity,  bor- 
dered on  each  side  by  a  fold,  wliicli  will  resemble  the 
labium  majus  much  more  than  ordinarily  obtains  in 
these  cases  ;  the  urethra  failing  to  effect  its  fusion  beneath 
the  united  corpora  cavernosa,  there  is  hypospadias,  and 
often  cryptorchidia.  There  results,  then,  that  vice  of  con- 
formation which  is  made  the  subject  of  this  stud}^ ;  and 
which  allows  us  still  to  conclude  formally  that,  in  the 
great  majority  of  instances,  the  hermaphrodites  ought  to 
be  referred  to  the  male  sex. 

Thus,  as  Serres  has  remarked,  in  his  Organogenesie^  the 
foetuses  of  the  mammifera  pass  by  different  degrees  of  or- 
ganic formation,  which  correspond  in  their  transitory 
phases  to  the  normal,  constant  state  of  the  creatures  that 
are  placed  lowest  in  the  organic  scale ;  thus,  Is  not  the 
monstrosity  often,  he  asks,  the  persistenc^e  of  one  of  the 
transitor}^  phases  of  the  foetal  organization  I 

How  are  these  arrests  of  development,  located  in  the  va- 


*  Dutrochet.    Acad,  des  Sciences. 


HERMAPIIRODISM. 


25 


rious  ])arts  of  the  genital  organs,  to  be  explained  ?  Here 
again,  we  are  enabled  to  accept  the  considerations  given  by 
Serres,  regarding  the  preponderant  influence  of  the  vessels 
on  the  development  of  the  organs.  According  to  the. 
origin  of  these  vessels,  he  divides  them  into  three  orders, 
each  one  corresponding  to  a  subdivision  of  the  generative 
organs  ;  the  generative  organs  themselves  being  consti- 
tuted by  the  association  of  six  principal  sections.  More- 
over, this  fact  has  been  established  by  Is.  Gfeoffroy  Saint- 
Hilaire,  and  that,  too,  in  the  male  sex,  as  well  as  in  the 
female.  The  superior  division  receives  its  arteries  from 
the  aorta,  through  the  spermatic  artery,  or  the  utero- 
ovarian  artery  (ovarian,  spermatic)  ;  the  middle  division, 
from  the  hypogastric  artery,  through,  the  uterine  arteries, 
the  arteries  of  the  prostate,  the  internal  pudic,  etc.; 
finally,  the  inferior,  or  superficial  division  has  its  own 
arterial  network,  arising  from  the  external  iliac  artery, 
or  the  femoral,  through  the  external  x)udic  artery. 
Upon  these  data,  however,  his  explanations  are  rather 
more  philosophical  than  positive.  Serres  thus  founds  his 
conclusions,  in  order  to  show  how  the  arrests  of  develop- 
ment, which  constitute  hermaphrodism,  may  be  located 
either  in  the  two  inferior  symmetrical  divisions,  (for  ex- 
ample, absence  of  union  of  the  two  lateral  folds  which 
should  form  the  scrotum),  or  the  two  superior  divisions, 
(absence,  or  arrest  of  development  of  the  ovary  or  testicle), 
accordingly  as  the  arteries  of  the  inferior  or  superior 
divisions  are  obliterated  or  are  of  diminished  calibre. 

In  the  same  manner,  he  explains  the  facts  which  we 
have  considered  under  lateral  or  bisexual  hermaphro- 
dism ;  facts  that  nearly  all  modern  authors  reject,  as 
being  the  result  of  insufficient  observation.  Serres  pre- 
sumes that,  in  these  cases,  the  vascular  irrigation  being 
unequally  supplied  to  these  three  lateral  divisions,  there 
will  result  upon  one  side  an  incomplete  development,  and 
upon  the  other,  on  the  contrary,  a  true  hypertrophy ; 
consequently^  a  formation  of  female  organs  upon  one 
side,  and  male  organs  upon  the  opposite  side. 


26 


HERMAPHRODISM. 


We  have  undertaken,  at  some  length,  to  state  these 
ingenious  explanations,  without  being  understood  as 
adoj^ting  purely  speculative  theories. 

Otlier  autliors  have  given  another  explanation  of  her- 
maphrodism  ;  I  will  limit  myself  to  the  simple  mention 
of  it ;  among  others,  I  will  cite  the  names  of  Is.  Geoffroy 
Saint  Hilaire,  Dutrochet  and  Marc.  According  to  these 
authors,  who  assume  as  the  foundation  of  the  funda- 
mental law  of  the  development  of  tlie  sexual  apparatus, 
that  the  most  complete  analogy  exists  between  the  male 
and  female  organs,  to  that  degree,  even,  that  in  the  early 
moments  of  tlieir  formation,  it  is  not  easy  to  distinguish 
them  ;  and  that  later,  each  part  of  the  male  apparatus 
has  its  analogue  in  the  female  apparatus,  and  recipro- 
cally ;  according  to  these  authors,  I  say,  it  is  not  till  the 
end  of  a  certain  period  of  intra-uterine  life,  that  these  ele- 
ments, primitively  neuter,  will  become  male  or  female, 
according  to  the  reciprocal  impulses  transmitted  from 
the  male  ovule  to  the  female  ovule.  This  is  the  theory 
that  we  are  enabled  to  call  the  neutrality  of  the  sexes 
during  intra-uterine  life,  which  will  explain  why,  under 
certain  given  circumstances,  the  transmitted  impulse  is 
insufficient  to  bring  about  a  normal  development,  and, 
consequently,  the  entire  series  of  analogous  transforma- 
tions in  the  different  divisions  of  the  generative  organs. 

Another  school  supposes  the  following  principle  ;  and 
admits  a  normal  pliysiological  bisexuality.  According 
to  the  leaders  of  this  school,  every  foetus  possesses  the 
two  sexual  apparatuses  capable  of  taking  on  a  complete 
development,  but  usually,  and  especially  according  to 
the  law  of  Serres,  known  under  that  of  the  equilibrium 
of  the  organs,  one  of  these  apparatuses  should  normally 
atrophy  ;  whence  results,  in  consequence,  a^  complete 
male  or  female  sexual  apparatus.  But,  for  another 
reason,  still  ignored  :  the  laws  of  nature  suffer  a  devia- 
n,  in  order  that  there  may  be  any  arrest  of  develop- 
ment, the  homogeneity  is  destroyed,  and  the  consequence 


HERMAPHRODISM. 


27 


will  be  the  formation  of  the  generative  apparatus,  after 
an  extravagant  and  singular  fashion,  exhibiting  the  union 
of  the  male  and  female  organs.  This  is  an  extremely 
ingenious  theory,  but  it  cannot  resist  one  serious  criticism 
founded  upon  the  recent  results  of  modern  embryology, 
and  especially  of  histology.  Nevertheless,  it  is  apparent 
how  easy  it  will  be  to  explain,  by  this  means,  the  posi- 
tive, but  exceptional  facts  of  bisexual  hermaphrodism, 
such  as  we  have  detailed  in  our  observations  Y  and  V I. 

In  conclusion,  I  will  call  attention  to  the  complete 
independence,  the  slight  relations,  so  to  speak,  which 
exist,  at  least  during  the  first  months  of  intra-uterine  life, 
between  the  fundamental  organs  of  •  generation  and  the 
accessory  organs,  in  both  sexes  ;  "  whence  results,"  says 
Professor  Tardieu,  ' '  upon  the  one  hand,  the  possibility 
of  an  incomplete  evolution,  which  will  retain  certain 
parts  in  a  primitive  state,  whilst  other  parts  will  develop 
normally  ;  and  upon  the  other  hand,  the  confusion  of  the 
characteristics  of  the  sex,  which  will  be  female  on  one 
side  and  male  on  the  other." 

APPLICATIOl^    OF  THE   PRECEDING   DATA   TO  LEGAL 
MEDICINE. 

Several  medico-legal  questions  of  great  gravity  belong 
to  the  vices  of  conformation  of  the  sexual  organs. 
Sometimes  the  individuals,  who  have  had  a  false  social 
rank  from  the  time  of  birth,  are  condemned  to  a  series  of 
moral  disturbances,  before  being  able  to  recover  their 
title,  and  to  receive  their  common  right.  Sometimes 
a  marriage,  contracted  under  the  conditions  of  identity 
of  sex,  has  been  declared  null.  As  M.  Tardieu  has  said, 
''from  all  the  points  of  view,  moral,  physiological  and 
social,  these  facts  are  of  a  nature  to  interest  profoundly 
the  philosopher  and  the  physician." 

The  essential  object  of  marriage  being  the  union  of  the 
sexes,  it  results  from  this,  that  the  difference  of  sex  is  the 
essential  condition ;  article  144  of  the  Civil  Code  sup- 


28 


HERMAPHRODISM. 


poses  this  condition,  otherwise  a  marriage  does  not  exist. 
Also,  when  by  a  concourse  of  extraordinary  circumstances, 
of  which  numerous  examples  are  found  in  our  old  laAv, 
and  even  in  the  present,  (decree  of  the  Parliament,  1765, 
decree-  of  the  court  of  Treves,  1808),  when  a  union  so 
monstrous  is  found,  there  is  not  a  marriage,  but  a  rejpre- 
sentation  of  marriage. 

If  the  apparent  silence  of  the  Code,  on  the  variety  of 
causes  of  impotence,  has  been  the  cause  of  the  division 
which  still  reigns  among  the  jurists,  it  seems  difficult  to 
us,  on  the  other  hand,  to  include  liermaphrodism  among 
the  causes  of  impotence^  as  M.  Legrand  du  Saulle  has 
said,  when  that  impotence,  even  the  most  notorious,  is 
not  a  cause  of  opposition  to  the  marriage ;  on  the  con- 
trary, ai  ticle  180  of  the  Civil  Code  sufficiently  instructs 
the  physician  and  the  judge  concerning  the  vices  of  con- 
formation, which  constitute  liermaphrodism.  In  fact, 
such  are  the  expressions  of  the  Code,  when  there  is  a 
fault  in  the  'person,  the  marriage  cannot  be  challenged 
b}^  another  than  one  of  the  two  espoused  who  has  been 
led  into  error. 

The  law  not  having  made  mention  of  tlie  word  barren- 
ness, we  should  give  to  the  w^ord  impotence  a  legal  sig- 
nificance quite  different,  and  much  more  comprehensive, 
than  when  the  same  word  is  employed  in  a  strictly  med- 
ical sense.  Always  under  the  circumstances,  when  the 
impotence  has  been  well  marked,  the  courts  have  simply 
compared  the  fact  to  the  cases  in  which  there  has  been 
a  fault  in  the  person,  such  as  enables  us  to  pronounce 
upon  the  invalidity  of  the  marriage. 

IS'ot  wishing  to  further  enlarge  upon  the  causes  of  im- 
potence, or  upon  the  manner  of  proceeding  in  order  to  dis- 
cover the  truth  and  to  render  it  visible  and  palpable,  so  to 
speak,  to  the  eyes  of  the  court,  especially  when  con- 
cerned with  questions  so  delicate,  we  will  now  examine 
the  different  questions  which  can  be  submitted  to  the 
medical  expert,  constantly  recalling  the  fact  that,  in  the 


HERMAPHRODISM. 


29 


majority  of  instances,  there  is  a  fault  in  tlie  person  ;  and 
that  it  is  this  fact  whicli  establishes  either  the  invalidity 
of  the  marriage,  or  demands  simply  the  revision  of  the 
social  state,  in  consequence  of  a  vicious  conformation 
of  the  genital  parts,  which  has  given  rise  to  the  doubt  or 
the  fault. 

Consider  the  first  case,  that  which  is  presented  most 
commonly,  under  circumstances  that  are  generally  well 
indicated.  Marc,  and  Orfila,  in  their  treatises  on  legal 
medicine,  have,  among  others,  reported  the  history  of 
Marie  Marguerite,  who,  wishing  to  marry,  was  visited  by 
a  surgeon  on  account  of  the  absolute  absence  of  menstru- 
ation ;  and  because  of  which,  the  tribunal  of  Dreux  had 
directed  her  to  assume  male  attire.  Briand  and  Chaude 
also  speak  of  this  individual  who,  christened  and  edu- 
cated as  a  girl,  one  day  demanded  the  privilege  of  marry- 
ing a  woman  whose  pregnancy  was  due  to  his  efforts. 

The  same  authors  still  further  express  themselves : 
"  Marriage  cannot  be  otherwise  contracted  than  between 
two  persons  of  different  sex  ;  if  it  is  to  be  supposed  that  a 
marriage  might  have  been  contracted  between  a  woman 
and  an  individual  who,  up  to  that  time,  had  been  regarded 
as  belonging  to  the  male  sex,  but  who  really  was  a 
woman,  as  she  was,  will  any  one  dare  to  assume  that  such 
a  marriage  is  valid  ?  l^o  ;  without  doubt  such  a  union 
ought  evidently  to  be  annulled,  because  of  error.  Let 
one  suppose,  on  the  contrary,  an  individual  in  whom  a 
freak  of  nature  had  given  birth  to  a  rudimentary  virile 
organ,  is  there  not  equally  in  this  case  an  error  in  the 
person  l  In  both  cases,  the  justice  of  the  decision  is  the 
same,  icbl  eadem  ratio,  idem  jus.  It  is  necessary  to 
annul  such  a  marriage."  Moreover,  it  was  thus  that  the 
case  was  decided  which  came  at  first  before  the  tri- 
bunal at  Alais,  in  1869  ;  I  desire  to  recall,  in  a  few  lines, 
the  interesting  particulars  in  this  case.  M.  D.  was  mar- 
ried in  1866  to  a  person  inscribed  on  the  register  of  civil 
state  under  the  name  and  surname  of  Justine  A.  Z.,  then 


30 


HERMAPHRODISM. 


twenty-five  years  of  age.  In  1869,  only,  he  decided  to 
demand  the  nullification  of  his  marriage,  for  which  he 
alleged  the  following  motives :  according  to  his  own  obser- 
vations and  those  of  a  midwife,  this  pretended  married 
woman  did  not  possess  a  single  organ  which  characterizes 
the  female  sex  ;  she  had  neither  breasts,  ovaries,  uterus 
nor  vagina  ;  her  pelvis  was  conformed  to  that  of  the  male 
rather  tlian  to  that  of  the  female  ;  moreover,  though  she 
was  twenty-seven  years  of  age,  she  had  never  had  either 
menses  or  periodical  lumbar  and  abdominal  pains.  After 
a  first  decision  had  been  reversed  by  the  Imperial  Court 
of  Nimes,  which  among  other  considerations  gave  the  fol- 
lowing :  ''While  the  law  has  not  included  impotence 
with  the  causes  for  nullifying  a  marriage,  it  follows  that 
every  demand,  tending  to  prove  that  one  of  the  espoused 
is  found  in  that  state,  should  be  rejected,"  the  cause 
was  then  submitted  to  the  supreme  court.  It  was  then 
that  M.  Tardieu  was  appealed  to  for  his  opinion. 

"The  intervention  of  the  physician,  indispensable  in 
such  cases,  is  perfectly  defined  in  its  object,  and  should 
be,  at  the  same  time,  perfectly  distinct  in  its  results.  The 
question  to  decide  is  expressed  in  these  very  simple 
terms :  the  person  espoused  as  a  woman,  is  she  a  mal- 
formed Avoman,  impotent  and  unfit  for  sexual  union? 
In  this  case,  there  is  not  a  cause  for  divorce,  in  the  re- 
stricted sense  the  law  has  fixed.  Is  he  a  malformed  man 
offering  the  deceitful  appearances  of  the  female  sex  ? 
In  this  case,  the  marriage  has  not  even  existed,  and  is 
radicall}^  wrong.  A  medico- legal  expert  is,  without 
doubt,  necessary  and  indispensable,  for  the  solution  of  the 
double  question  that  I  have  just  indicated." 

Relying  upon  a  very  incomplete  certificate,  given  by 
Dr.  C — ,  M.  Tardieu,  taking  as  a  foundation  for  his 
scientific  argument,  the  general  conformation,  the  nar- 
rowness of  the  pelvis,  the  negative  development  of  the 
breasts,  the  absence  of  the  vagina,  but  especially  the  abso- 
lute failure,  not  only  of  the  original  menstrual  flow,  but 


« 


HERMAPHRODISM.  31 

even,  at  that  time,  of  the  periodical  flux,  accompanied  by 
lumbar  or  abdominal  pains,  with  swelling  of  the  breasts, 
arrived  at  the  conclusion,  that  this  person,  not  possessing 
in  reality  a  single  organ  essential  to  the  constitution  of 
the  female  sex,  was  a  man,  but  a  malformed  man,  pre- 
senting the  most  common  type  of  hermaphrodism. 

In  adding  to  his  report,  M.  Tardieu  recalled  the  fact 
that,  from  a  medico-legal  point  of  view,  sexual  indilfer- 
ence,  or  absolute  neutrality  does  not  exist ;  and  Briand 
and  Chaude  themselves,  after  having  admitted  theoreti- 
cally this  variety  of  hermaphrodism,  say  that,  from  a 
medico-legal  point  of  view,  "these  individuals  should 
be  regarded  as  being  of  the  masculine  sex  ;  because, 
in  them  the  female  genital  parts  cannot  be  discovered ; 
and  the  absence  of  virility  depends  only  then  upon  the 
want,  or  the  atrophy  of  the  testicles/' 

The  case  was  only  decided  in  1873,  and  the  court 
annulled  the  marriage  inscribed  on  the  registers  of  the 
civil  state  of  the  commonwealth  of  Alais. 

One  can  resume  all  which  has  preceded,  in  saying 
that,  if  the  impotence  or  the  infecundity  of  the  espoused 
cannot  be  admitted  as  a  cause  for  nullification  of  mar- 
riage, it  is  not  the  same  for  identity  of  sex,  which  requires 
most  often  a  declaration  of  fault  in  the  person,  and  con- 
sequently establishes  the  nullity  of  the  marriage.  This 
case  is  certainly  the  most  difficult  which  can  be  submitted 
to  the  examination  of  the  medical  expert. 

ERRORS  IN  THE   INSCRIPTIO]^-  OF  THE  SEX  IjS^  THE  CIVIL 

STATE. 

In  addition  to  the  foregoing  facts,  there  remains  to  be 
considered  the  errors  in  the  inscription  of  the  sex  in  the 
ciml  state.  These  facts  have  a  capital  importance  ;  be- 
cause, if  an  error  is  committed,  there  will  result  a  series  of 
disastrous  consequences  which  I  have  just  indicated  in 
the  preceding  pages. 

It  will  be  remembered  that  the  greater  part  of  the  vices 


IIERMAPHRODISM. 


of  conformation  are  the  result  of  an  arrest  in  development, 
the  subject  of  which,  in  the  immense  majority  of  cases, 
is  an  individual  belonging  to  the  male  sex  ;  and  that  the 
malformations  of  the  sexual  organs  of  tlie  female,  are 
much  more  easy  to  recognize,  especially  on  account  of 
the  multiple  and  varied  manifestations  the  ovaries  are 
subject  to,  by  the  aid  of  which  their  presence  is  made 
known. 

When  the  physician  is  appealed  to,  to  pronounce  upon 
the  sex  of  the  person,  often  for  the  purpose  of  reinstat- 
ing an  individual  in  his  true  civil  rank,  who  has  had 
attributed  to  him  a  sex  that  was  not  his  own,  he  should 
follow  from  point  to  point  the  line  of  conduct  which  has 
already  been  clearly  indicated  by  Marc  :  1,  to  observe  at- 
length,  and  under  several  aspects,  the  tastes,  the  habits, 
and  the  moral  constitution  of  the  individual  ;  2,  after  an 
inspection  of  the  entire  surface  of  the  body,  to  estab- 
lish the  sex,  the  characters  of  which  seem  to  predominate  ; 
3,  to  examine  with  the  greatest  care  the  external  organs 
of  generation  (23enis,  scrotum,  urethra,  testicles);  to 
sound  all  the  openings,  in  order  to  know  the  extent  and 
direction  and  the  character  of  the  vices  of  conformation, 
which  conceal  the  true  sex  ;  4,  to  be  assured,  finally,  if 
there  has  ever  been  established  an  issue  of  catamenial 
blood ;  for  this  fact  alone  is  sufficient  to  unveil  the 
predominance  of  the  attributes  of  the  woman. 

Sometimes  the  true  sex  remains  unknown  throughout 
the  entire  life  ;  as  in  the  case  of  Maria  Arsans,  who  died 
at  the  age  of  eighty,  who  was  a  reputed  woman  and  was 
married  as  such ;  but  the  autopsy  showed  in  her  some 
signs  of  virility.  Sometimes  an  accidental  circumstance, 
such  as  the  descent  of  the  testicles,  or  their  strangulation 
in  the  ring,  awakens  the  attention. 

One  of  the  most  affecting  and  dramatic  observations, 
is  that  of  the  poor  unfortunate,  who  lived  in  a  convent 
boarding-school,  almost  to  the  age  of  twenty-two  years, 
and  who,  by  a  series  of  multiple  circumstances,  saw  his 


HERMAPHRODISM. 


33 


own  civil  rank  changed  by  a  decree  of  tlie  civil  tribunal 
of  Roclielle.^'    The  history  of  this  individual,  vrhose 

name  was  Alexina  B  ,  has  been  written  by  himself, 

and  shows  what  terrible  consequences  can  come  from 
an  error  committed  in  the  inscription  in  the  civil  state. 
This  person,  the  prey  of  a  miserable  existence,  committed 
suicide,  in  Paris,  in  1868  ;  the  autopsy  showed  very  evi- 
dently that  he  was  a  man  ;  the  body  had  all  the  exterior 
appearances  of  a  man,  the  hair  system  was  very  well 
developed,  the  penis  existed,  and,  moreover,  there  w^ere 
testicles. 

In  order  to  avoid  similar  errors,  it  is  especially  essen- 
tial to  consult  the  physicians  who  have  attended  upon 
the  births  ;  ^'  and  not  to  be  content  with  the  declarations 
of  the  parents,  or  the  persons  who  witnessed  the  accouch- 
ment,  but  to  ascertain  for  one's  self  the  sex  of  the 
infant." 

Sometimes  there  are  circulnstances  under  which  it  will 
be  very  difficult  to  pronounce  immediately;  ''in  these 
cases,"  saidM.  Legrand  du  Saulle,  "cannot  one  postpone 
the  decision,  as  in  a  consultation  of  the  guard  of  the 
seals,  in  1811;  and  will  not  this  postponement  be  prefera- 
ble to  a  hasty  affirmation,  founded  upon  hypotheses,  and 
analogies,  and  which  can  entail  many  disastrous  conse- 
quences 

One  other  medico-legal  question  should  engage  our 
attention,  the  solution  of  which,  we  are  forced  to  admit, 
is  not  easy  ;  we  allude  to  the  capability  of  the  hermaph- 
rodites for  procreation  and  their  fitness  for  marriage. 

Take,  for  example,  the  case  of  Alexina  B  ,  in  w^hom 

the  penis  was  of  small  size  ;  after  the  rectification  of  her 
civil  rank  had  been  obtained,  could  Alexina  then  marry? 
Was  there  reall37^  impotence  ?  Yes  ;  according  to  M.  Le- 
grand du  Saulle  ;  ' '  because,  though  the  act  of  copulation 
could  be  well  accomplished,  fecundation  is  really  impos- 
sible.   It  remains  evident  that  Alexina  B         is  an  un- 

*  Chesnet.  Annales  d'hyg.  et  de  m6d.  l(5gale,  1868. 
3 


34 


HERMAPHEODISM. 


classed  being,  incapable  of  reproduction,  and  consecrated 
to  an  eternal  celibacy."    It  seems  to  me,  however,  that 

Alexina  B  presents  all  the  attributes  of  the  male  sex, 

and  that  some  day,  when  there  will  be  adopted  in  France 
the  singular  practice  of  certain  American  surgeons,  it 
will  be  no  longer  admissible  to  say  that  fecundation  by 
such  a  subject  is  in  reality  impossible. 

For  the  medical  jurist,  we  will  admit  only  two  classes 
of  hermaphrodites :  in  the  first,  much  the  more  numer- 
ous, will  be  the  hermaphrodites  whose  sex  is  recognizable  ; 
tlie  most  frequently  they  will  be  individuals  of  the  male 
sex,  who  will  be  able  to  marry  (the  impotence  not  being 
absolute),  or  of  the  female  sex  who  cannot  marry,  their 
sexuality  not  being  sufficiently  distinct. 

In  the  second  class,  will  be  those  individuals  whose  sex 
cannot  be  defined.  These  are  the  persons  whom  Is. 
Geoff roy  Saint- Hilaire  designates  under  the  name  of  neg- 
ative, neuter  hermaphrodites  ;  the  sex  of  these  is  indeter- 
minable ;  arrested  in  their  development,  their  analogue 
is  found  only  in  the  embryo.  Or  rather,  there  may  be  an 
equal  association  of  the  two  api)aratuses.  It  is  of  this 
class  of  hermaphrodites,  that  Greoffroy  Saint-Hilaire  re- 
gretted "that  the  law  admitted  of  only  two  great  classes 
of  individuals,  upon  whom  it  imposed  different  obliga- 
tions and  accorded  to  them  different  privileges." 

Among  these  hermaphrodites,  the  aptitude  of  genera- 
tion does  not  exist,  the  sexes  being  so  imperfectly 
constructed,  and  they  can  neither  fecundate  nor  conceive. 
Concerning  the  marriage,  it  ought  to  be  declared  null, 
not  on  account  of  error  in  the  person,  but  because  of  the 
identity  of  sex  of  the  two  espoused. 

In  resume^  the  arrest  of  development  of  the  sexual  or- 
gans gives  origin,  finally,  to  a  medico-legal  question  of 
identity;  this  question  will  be  solved  generally,  after  a 
minute  examination  of  the  parts,  being  based  upon  the 
facts  furnished  by  anatomy,  physiology  and  embryology. 
Further,  the  greatest  frequency  of  the  vicious  confor- 


HERMAPHRODISM. 


35 


mation  of  the  male,  will  enable  us  to  conclude,  usually, 
that  we  have  to  do  with  individuals  of  the  male  sex. 

OBSERVATIONS. 

Observation  I,  (due  to  the  kindness  of  Dr.  Chatillon),  Ap- 
parent liermaphrodism  in  a  person  of  the  male  sex. 

P  ,  aged  nineteen  years,  had  resided  in  Paris  since  he  was 

five  years  old.  A  consultation  had  heen  held  a  long  time  pre- 
viously, at  which  MM.  Ricord  and  Clerc  were  present.  He 
wishes  now  to  know  if  he  can,  or  cannot  receive  a  carte^  which 
he  claims,  in  order  that  he  may  give  himself  more  fully  to 
prostitution.  It  was  decided  that  this  carte  should  be  refused  ; 
because,  P  was  a  man. 

He  was  considered  as  the  subject  of  complete  hypospadias, 
with  this  peculiarity,  that  the  penis  was  so  rudimentary  that  its 
volume  did  not  exceed  that  of  a  well  developed  clitoris.  The 
urethral  canal  was  larger  than  normal,  but  it  terminated  in  the 
bladder  and  not  in  a  vagina.  The  rectal  touch  did  not  permit 
one  to  feel  an  uterus,  nor  had  menstruation  been  established* 
However,  the  general  configuration  of  the  body,  the  aspect  of 
the  face,  the  quality  of  the  voice,  are  rather  those  of  the  woman; 
the  breasts,  moreover,  are  quite  rudimentary;  the  skin  is  smooth 
in  those  places  where  it  normally  is  in  the  woman. 

Concerning  the  tastes  of  P  ,  they  appear  to  be  those  of  a 

woman,  and  he  denies  with  energy,  and  angrily,  the  accusation 
made  against  him,  which  is  that  he  has  a  predilection  for 
women. 

In  this  instance,  despite  the  external  appearances,  the 
tastes  and  the  feminine  aptitudes,  one  ought  to  conclude 
that  this  is  simply  a  case  of  arrest  of  development  of  the 
sexual  parts,  accompanied  by  cryptorchidia. 

Obs.  II.  Apparent  hermaphrodism  in  an  individual  of  the 
male  sex. 

In  the  month  of  December,  1873,  there  entered  la  Pitie,  hall 
Saint-Jean,  in  the  service  of  M.  Labbe,  a  person  presenting  one 
of  the  most  remarkable  instances  of  hermaphrodism.    This  ac- 


36 


HERMAPHRODISM. 


count  may  appear  a  little  too  imperfect;  but  I  was  only  able  ta 
procure  the  following  details,  which,  however,  are  much  the 
most  important. 

In  November,  1873,  a  young  girl  of  about  seventeen  years, 
living  in  Asnieres,  went  to  consult  a  physician  for  a  crural 
hernia.  While  examining  this  hernia,  he  was  much  surprised 
to  find  a  penis  as  voluminous  as  that  of  the  majority  of  young- 
men  of  that  age.  The  penis  had  a  prepuce  which  could  be 
made  to  cover  it  entirely,  but,  from  habit,  the  penis  was  uncov- 
ered almost  to  the  corona  glandis;  it  presented  no  trace  of  the 
canal  of  the  urethra.  On  the  lateral  parts,  one  could  not  recog- 
nize either  the  labia  majora  or  nymphae,  not  even  the  slightest 
fold  which  could  be  considered  rudimentary.  But,  between  the 
penis  and  the  anus,  almost  equi-distant  from  both,  there  was  an 
oval  opening,  which  alloAved  with  difficulty  the  passage  of  the 
little  finger,  and  which  could  be  penetrated  but  a  little  way,  be- 
cause of  the  violent  pains  which  were  provoked  by  the  attempt. 

The  patient  urinated  through  this  oval  orifice.  It  has  been 
impossible  to  ascertain  if,  at  the  extremity  of  this  canal,  the 
uterus  could  be  found,  on  account  of  the  narrowness  of  the 
parts:  the  rectal  touch  even,  in  this  connection,  has  only 
furnished  negative  information. 

This  pretended  young  girl  had  never  had  her  catamenia;  her 
features  were  rather  those  of  a  man  than  of  a  woman;  she  had 
no  beard,  but  the  loud  voice  was  masculine;  the  breasts  were 
markedly  developed. 

The  presence  of  the  testicles  could  not  be  established.  The 
person  admitted  that  she  experienced  a  great  pleasure  when  she 
was  with  the  young  girls,  and  seems  to  have  felt,  on  several  oc- 
casions, when  touched  by  them,  some  voluptuous  sensations, 
but  has  never  had  manifest  ejaculations. 

The  conformation  of  the  penis,  the  presence  of  the  glans  en- 
veloped by  a  prepuce,  the  absence  of  the  labia  majora  and 
nymphae,  but  especially  the  negative  results  obtained  from  the 
search  for  the  uterus  and  ovaries,  and  the  absence  of  the  multi- 
ple facts  which  could  make  known  a  menstrual  elaboration, 
permit  us  to  conclude,  especially  in  view  of  the  external  physical 
characteristics,  that  this  pretended  young  girl  has  been,  to  this 
time,  incorrectly  entered  on  the  registers  of  civil  state  as  being 


HERMAPHRODISM. 


37 


of  the  female  sex,  but  who  is,  in  reality,  a  male,  in  whom  the 
development  of  the  external  genital  parts  presents  a  malforma- 
tion well  known  in  science. 

Obs.  Ill,  (due  to  the  extreme  kindness  of  my  learned  master, 
M.  Gueneau  de  Mussy).  Apparent  hermaphrodism  in  the  male 
sex. 

In  1848,  I  was  consulted  by  a  woman  for  her  daughter,  who, 
eleven  years  of  age,  had  for  some  time  exhibited  many  disturb- 
ances of  her  health.  I  was  immediately  struck  by  the  walk  of 
this  child;  there  was  something  masculine  in  her  physiognomy, 
and  in  her  manner;  the  volume  of  the  chest  was  noticeable  at 
the  base;  supposing  a  malformation,  I  demanded  of  the  mother 
if  her  child  presented  nothing  peculiar;  she  responded  to  me, 
Mushing,  that  there  Avas  something  extraordinary  in  her  con- 
formation, but,  till  then,  she  had  preserved  the  most  absolute 
secrecy  respecting  this.  At  my  solicitation,  the  mother  sub- 
mitted her  child  to  my  examination,  and  this  is  what  I  recognized. 
The  pubis  was  covered  with  hair,  and  had  been  since  the  age  of 
five,  according  to  the  mother.  Beneath  the  pubis,  there  existed 
a  sort  of  penis,  having  a  length  of  about  two-thirds  of  an  inch, 
and  terminating  in  a  slightly  swollen  e-xtremity;  on  its  inferior 
surface,  there  was  a  groove,  representing  the  superior  wall  of 
the  urethra,  continuing  beyond  at  the  level  of  the  orifice  of  a 
veritable  canal,  which  opened  behind  the  base  of  the  penis. 
Still  posteriorly,  there  existed  a  kind  of  vulva,  bordered  by  two 
rudimentary  labia;  this  vulva  limited  inferiorly  a  little  vagi- 
nal canal,  into  which  I  could  introduce  my  little  finger,  and 
which  terminated  superiorly  in  a  cul-de-sac.  There  was  no 
trace  of  the  testicles,  either  in  the  labia,  or  at  the  level  of  the 
rings.  Having  introduced  a  sound  into  the  bladder,  and  my 
index  finger  into  the  rectum,  I  was  enabled  to  recognize  that 
my  finger  was  separated  from  the  sound  only  by  a  membrane, 
and  consequently  I  was  able  to  conclude,  with  approximative 
certainty,  that  the  uterus  did  not  exist. 

The  principal  details  of  this  observation  permit  us 
thus  to  affirm  the  existence  of  a  masculine  sexuality, 


38 


HERM  APHROD  ISM . 


with  arrest  of  development,  which  had  an  apparent  sim- 
ilarity of  the  external  genital  organs  to  those  of  the- 
female  sex. 

Obs.  IV.  Hermaphrodism  with  sex  imperfectly  defined. 
(Personal  observation). 

In  1867,  when  I  was  physician  of  the  District  of  ,  I  was 

asked  by  one  of  my  countrymen  to  attend  one  of  his  friends. 
Upon  reaching  the  place,  I  found  myself  in  the  presence  of  a 
young  man,  attired  as  a  young  girl,  of  about  twenty-five  years 
of  age,  oflTering  a  remarkable  physiognomy,  encircled  by  a  head 
of  long  hair,  and  presenting  not  the  slightest  trace  of  moustache 
or  whiskers.  There  was  a  slight  something  in  the  manners  and 
carriage  of  the  person,  such  as  led  me  to  demand  unexpectedly 
if  he  was  a  man  or  a  w^oman. 

In  informing  me  of  his  trouble,  he  began,  blushing,  by  pray- 
ing me  to  preserve  with  the  greatest  secrecy  the  details  which  I 
should  observe.  Then  he  passed  into  his  chamber,  where  some 
minutes  after  I  found  him  in  bed. 

This  chamber  was  magnificently  ornamented  ;  innumerable 
perfumes  were  scattered  here  and  there  ;  everything,  in  a  word, 
in  the  apartment,  revealed  the  most  effeminate  coquetry. 

He  told  me  that  he  suffered  in  the  genital  parts  ;  when  I  pro- 
ceeded to  a  minute  and  attentive  examination  of  these  organs. 

The  clitoris  was  excessively  developed,  having  a  length  of  an 
inch  and  two-thirds,  or  two  inches  ;  at  its  summit  it  terminated 
in  an  enlarged  extremity,  quite  suggestive  of  the  glans  ;  this 
organ  was  imperforate.  Beneath,  there  was  a  little  opening 
through  which  the  patient  urinated,  leading  into  a  cavity  which 
admitted  the  finger  without  any  difiiculty.  Nevertheless,  it  was 
impossible  for  me  to  feel  the  neck  of  the  uterus,  and  there  was 
nothing  in  the  antecedents  which  showed  a  more  or  less  clearly 
defined  menstrual  elaboration.  The  labia  majora  were  normally 
formed.  On  the  internal  surface  of  the  right  labium,  there  was 
a  soft  chancre,  w^hich  had  been  communicated  by  the  gentleman 
who  had  solicited  my  attendance,  and  who,  I  was  told,  w^as  the 
lover  (I'amant)  of  the  patient.  The  pubis  was  covered  with 
hair.     NoW'here  was  there  any  trace  of  the  testicles.  The- 


HERMAPHRODISM. 


39 


thorax  was  large,  but  the  breasts  were  scarcely  developed  ;  the 
voice  was  perfectly  feminine. 

This  person  had  not  the  slightest  predilection  for  women. 
Being  possessed  of  a  great  fortune,  he  retained  in  his  service  a 
personnel  of  male  domestics. 

Subsequently,  on  several  occasions,  I  saw  him  dressed  in  the 
most  fantastic  costumes,  in  garments  of  brilliant  colors.  At 
home  he  always  remained  clothed  as  a  woman,  but  when  he  went 
out,  he  wore  male  garments. 

In  this  observation,  the  positive  conclusion  seems  very 
difficult,  and  we  are  inclined  to  offer  the  opinion  that 
this  is  a  instance  of  hermaplirodism  in  wliich  it  is  impos- 
sible to  define  the  sex.  The  absence  of  the  testicles,  not- 
withstanding the  abnormal  development  of  the  penis, 
forces  one  to  question  a  masculine  sexuality,  while  the 
absence  of  all  menstruation,  the  absence  of  the  uterus 
and  ovaries,  prevents  us  from  concluding,  in  a  positive 
manner,  upon  a  feminine  sexuality. 

Obs.  V.    Bisexual  hermaphrodism. 

Dr.  Ceccherelli  published  in  the  journal  Lo  Sperimentale^  of 
February,  1874,  (Florence),  the  description  of  an  hermaphro- 
dite whom  he  had  been  called  to  examine.  The  subject  had 
already  been  studied  by  Rokitansky,  Seultz,  and  especiahy  by 
Virchow,  who  had  published  a  description  of  him  in  his  Archives 
of  Pathological  xhiatomy. 

This  monster  is  forty  years  old.  The  breasts  are  largely  de- 
veloped and  pendulous  ;  the  right  eye  is  larger  than  the  left. 
The  penis  at  the  meatus  has  hypospadias  ;  but  a  sound  can  be 
entered,  which  reveals  another  opening,  two-thirds  of  an  inch 
from  the 'meatus,  through  which  the  urine  and  spermatic  fluid  is 
passed.  There  is  but  one,  very  well  developed  testicle.  The 
penis  and  scrotum  on  the  right,  and  the  prepuce  on  the  left,  is 
the  arrangement  which,  till  recently,  had  been  mistaken  for  a 
vulva,  and  the  person  had  been  considered  as  belonging  to  the 
female  sex,  and  had  received  the  name  of  Catherine.  The  glans 
had  been  mistaken  for  the  cUtoris.    In  introducing  the  finger 


40 


HEEMAPHRODISM. 


between  the  two  folds,  below  the  glans,  an  eminence  was  felt, 
having  all  the  characters  of  the  neck  of  the  uterus.  (Seultz). 

The  female  apparatus  is  complete,  and  is  situated  behind  a 
little  septum  formed  by  the  skin. 

Bilroth  had  proposed  the  incision  of  this  septum,  in  order  to 
make  more  evident  the  characters  of  the  female  sex,  which  are 
more  in  keeping  with  all  the  other  signs  of  the  hermaphrodism. 
The  catamenia  have  always  been  regular  till  within  the  past 
two  years.  He  has,  moreover,  accomplished  the  function  of 
copulation  of  the  female  sex.  The  prostate  cannot  be  reached, 
on  account  of  the  uterus.  The  vesiculae  seminales  exist,  without 
doubt,  for  Catherine  is  able  to  be,  in  turn,  the  active  party  of 
coition,  and  the  sperm,  which  has  been  examined  by  Virchow, 
contains  spermatozoids.    (Prog.  Med.,  1874.) 

This  observation  appears  to  us,  to  be,  notwithstanding 
tlie  brevity  of  the  details  which  have  been  given  to  us, 
one  of  the  clearest  examples  of  bisexual  hermaphrodism  : 
and  from  a  medico-legal  point  of  view,  it  seems  to  us 
that  it  will  be  very  difficult  to  establish  the  civil  rank  of 
this  person,  for  the  female  sexuality  appears,  at  least,  as 
evident  as  the  male  sexuality.  But,  in  view  of  similar 
cases,  considering  especially  the  positive  results  furnished 
by  the  examination  of  the  sperm,  and  further,  on  the 
contrary,  that  utero-ovarian  fecundation  will  be  impos- 
sible on  account  of  the  abnormal  septum,  we  would  not 
hesitate,  under  parallel  circumstances,  to  pronounce  in 
favor  of  a  male  sexuality,  and  to  inscribe  as  males,  on 
the  registers  of  civil  state,  all  persons  who  exhibit  the 
same  vices  of  conformation. 

Obs.  VI.  Bisexual  hermaphrodism.  By  M.  Odin,  Interne 
of  the  Hospitals.* 

Nat.  Per.,  day  laborer,  aged  sixty-three  years,  born  at  Millery, 
(Rhone),  entered  the  Hotel-Dieu,  of  Lyon,  June  10,  1873,  in  a 
state  of  absolute  coma,  resulting  from  an  attack  of  apoplexy 

*  Lyon  Medical,  No.  13  (21  Juin,  1874.) 


HERMAPHRODISM. 


41 


on  that  day,  and  died  on  the  fourteenth  of  the  same  month 
without  regaining  his  consciousness. 

The  autopsy  made  on  the  following  day,  under  the  direction 
of  Dr.  Bondet,  showed  traces  of  an  abundant  cerebral  haem- 
orrhage, which  had  caused  the  coma  and  death. 

The  subject  is  of  medium  height  ;  body  considerably  ema- 
ciated ;  the  extremities  are  short,  slim  and  rounded  ;  the  hands 
and  feet  are  small;  the  skin  fine.  The  pelvis  is  narrow  and 
contracted;  the  hips  approach  each  other;  in  a  word,  it  has  the 
masculine  conformation. 

There  is  but  a  slight  growth  of  hair,  though  the  scalp  and 
pubis  are  well  covered,  while  the  axillae  have  scarcely  any  hair ; 
the  remainder  of  the  surface  is  bare,  and. the  surroundings  of 
the  anus  entirely  so. 

He  has  no  breasts,  but  the  nipples  are  well  developed. 

The  genital  organs  present  :  first,  a  penis  surmounted  by  a 
glans;  this  is  imperforate;  it  has  a  corona  at  its  base  and  a  furrow 
on  its  interior  surface.  It  is  covered  with  a  prepuce  throughout 
its  entire  extent,  save  at  the  inferior  part  at  the  level  of  the 
furrow. 

The  penis,  measured  on  the  cadaver,  was  three  and  one-third 
inches  in  length,  and  nearly  of  the  normal  size.  Upon  its 
inferior  surface,  there  was  a  furrow,  continuous  with  that  at  the 
glans  which  termiated  in  an  orifice,  situated  below  and  in  front 
of  the  pubis,  through  which  the  urine  flowed.  The  penis  is 
inserted  at  the  commissure  of  the  labia  majora  which  gives 
origin  to  it,  being  continuous  with  the  skin  that  covers  it  like 
a  hood,  resembling  the  clitoris. 

The  scrotum  is  cleft,  and  has  the  aspect  of  the  labia  majora 
covered  with  hair  on  their  exterior,  but  smooth,  having  a  semi- 
mucous  surface,  on  their  internal  surface.  They  terminate  in 
front  in  uniting  at  the  root  of  the  penis,  and  inferiorly  by 
gradually  becoming  thinner,  and  without  uniting  to  form  a 
fourchette. 

At  the  bottom  of  the  space  included  between  the  labia  majora, 
is  the  median  raphe  of  the  perineum,  which  extends  from  the 
urinary  orifice  to  the  anus,  and  measures  two  and  one-third 
inches. 

On  the  right  side,  near  the  inguinal  ring,  there  is  a  little 


42 


HERMAPHRODISM. 


rounded  tumor,  of  the  size  of  a  pigeon's  egg,  which  contains  a 
little  body,  round  and  movable. 

On  the  other  side,  the  ring  has  no  tumor  analogous  to  the 
preceding,  it  is  entirely  free. 

In  catherizing  the  urinary  orifice,  one  arrives  at  very  different 
results  according  as  he  follows  the  anterior  or  posterior  wall 
of  the  canal.  In  following  the  first,  the  bladder  is  reached; 
but  in  following  the  second,  one  reaches  a  very  deep  cavity 
situated  behind  the  bladder. 

From  the  external  examination,  it  is  shown  that  we  have  to  do 
with  an  hermaphrodite  belonging  to  the  male  sex,  from  the 
presence  of  a  penis  a  little  irregular,  a  testicle,  and  the  absence 
of  the  breasts  and  the  form  of  the  pelvis  ;  and  to  the  female 
sex,  by  the  presence  of  the  labia  majora,  the  slight  development 
of  the  hair  upon  the  surface,  the  general  aspect  of  the  body,  and 
the  existence  of  a  cavity  behind  the  bladder,  revealed  by  the 
catheter. 

Notwithstanding  these  numerous  similarities  to  the  female 
sex,  it  seems  more  rational  to  assign  this  person  to  the  male  sex, 
to  which  he  belonged  during  his  life. 

The  internal  generative  organs  are  still  less  characteristic  of 
the  sex  of  the  person. 

Beginning  at  the  orifice,  which  we  have  described,  there  is  a 
canal  of  uniform  calibre,  an  inch  and  a  third  in  length,  and  one- 
third  of  an  inch  in  diameter,  lined  with  mucous  membrane 
which  is  continuous  with  that  of  the  labia  majora  ;  it  termi- 
nates posteriorly  by  an  orifice  completely  closed  by  an  annular 
membrane  like  a  hymen. 

Anterior  to  this  hymen,  on  the  anterior  wall  of  this  canal, 
there  is  a  smaller  orifice  which  leads  into  the  bladder  ;  this  is 
the  true  meatus  urinarius. 

This  canal  is  quite  anomalous,  it  being  neither  the  urethra, 
though  there  is  no  other,  nor  the  vagina,  it  being  anterior  to  the 
hymen.  It  is  a  canal  common  to  the  urine,  and  the  secretions 
from  the  vagina,  formed  by  the  two  nymphae  and  representing 
the  vulva. 

If  we  go  beyond  the  orifices  which  we  have  described,  by 
the  anterior,  the  bladder  can  be  reached,  through  a  canal  two- 
thirds  of  an  inch  long.    The  prostate  is  entirely  wanting.  By 


HERMAPHRODISM. 


43 


the  posterior  orifice,  the  vagina  is  reached,  ha\ang  a  -length 
of  about  three  inches  and  a  circumference  of  two  inches.  The 
mucous  membrane  lining  the  vagina  is  smooth,  and  has  no  trace 
of  columns.  There  is  a  little  mucus  in  this  cavity.  At  the 
superior  part,  there  is  a  slight  constriction,  which  is  directly 
continuous  with  the  lips  of  the  cervix  uteri,  without  forming  a 
cid-de-sac. 

The  uterus  has  a  large,  rounded  neck;  its  walls  are  thin,  with 
a  well  marked  arbor  vitJB. 

The  cervix  is  not  sensibly  distinct  from  the  body. 

The  body  is  rudimentary;  it  diminishes  in  size  from  the  neck 
towards  the  fundus,  becomes  rounded  and  terminates  in  a  long 
cord,  of  the  size  of  a  goose  quill,  and  inclined  to  the  left.  The 
cavity  of  the  uterus  is  two  and  two-thirds  inches  long;  it  ter- 
minates in  a  cul-de-sac.  The  uterus  is  received  into  a  fold  of 
peritoneum,  which  has  the  position,  the  direction  and  the  form 
of  the  great  ligaments.  It  even  has  the  three  aloe,  but  slightly 
marked. 

In  following  the  course  of  the  cord  in  which  the  uterus  ter- 
minates, a  fleshy  mass  is  reached,  situated  at  the  peritoneal 
orifice  of  the  inguinal  canal,  making  a  prominence  on  the  peri- 
toneal side.  It  is  enveloped  in  a  fold  of  peritoneum,  which  forms 
a  tunic,  analogous  to  the  tunica  vaginalis.  In  this  mass  there 
is  a  partially  developed  testicle,  surmounted  by  a  voluminous 
epididymis  ;  an  imperforate  Fallopian  tube,  with  a  well  formed 
pavilion,  and  the  fimbriated  extremity  directed  towards  an 
elongated  irregular  body,  covered  with  little  swellings,  and  even 
presenting  little  cysts.  This  body  is  probably  the  ovary,  which 
it  resembles,  though  the  microscope  has  not  revealed  the  presence 
of  ovules.  Between  the  Fallopian  tube  and  the  ovary,  there  is 
a  rudimentary  body  of  Rosenmiiller. 

Upon  the  left  side,  also,  there  exists  a  similar  fleshy  mass; 
but  here  it  is  situated  at  the  external  abdominal  ring,  where 
it  forms  a  tumor  as  described  above.  The  cord  which  is  united 
to  the  uterus  is  smaller  and  less  apparent.  The  testicle  is  a 
little  more  developed  than  on  the  opposite  side.  The  epididy- 
mis, the  ovary  and  the  Fallopian  tube  present  no  diflferences. 

The  testicles  are  united  to  the  vesiculge  seminales  by  the  vasa 
deferentia.    The  right  vas  deferens  is  the  larger  and  can  be 


44 


HERMAPHRODISM. 


followed  to  the  testicle,  but  the  left  cannot  be  traced.  The 
vesiculsB  seminales  are  situated  near  the  neck  of  the  bladder, 
in  front  of  the  vagina  ;  the  right  is  a  little  larger  than  the  left. 
The  ejaculatory  canals  probably  open  at  the  entrance  of  the 
canal  of  the  urethra,  at  which  point  there  are  several  small 
orifices;  but  the  canal  of  the  urethra  not  having  been  opened, it 
being  desirable  to  preserve  the  specimen,  I  am  not  able  to  affirm 
this  in  a  positive  manner. 

We  find  thus,  two  generative  apparatuses,  almost  complete, 
united  in  the  same  individual  ;  the  one,  male,  well  developed, 
but  wanting  the  prostate;  the  other,  female,  presenting  all  the 
organs,  but  developed  to  a  less  degree  than  the  former. 

To  what  sex  does  this  individual  belong?  To  no  sex  prob- 
ably. In  reality  he  had  testicles,  which  could  perhaps  furnish 
spermatozoids,  notwithstanding  their  small  size,  but  ejaculation 
being  impossible,  fecundation  was  rendered  extremely  difficult, 
not  to  say  impossible,  despite  the  fact  that  the  penis  was  capa- 
ble of  an  erection  and  even  intromission;  consequently  this  male 
being  is  condemned  to  impotence. 

The  female  being  possessed  some  of  the  attributes  of  her  sex; 
she  was  able  to  menstruate,  but  the  ovary  is  too  imperfect  to 
furnish  ovules;  the  Fallopian  tube  is  incapable  of  conducting 
them,  and  the  uterus  of  receiving  and  nourishing  them;  more- 
over, the  microscope  does  not  show  the  presence  of  ovules. 
Consequently  the  female  being  is  as  impotent  as  the  male 
being. 

Thus,  it  is  seen  that  this  hermaphrodite  is  equally  male  and 
female,  or  rather,  is  equally  impotent  as  male  and  female,  in- 
capable of  reproducing  with  either  sex,  less  fortunate  than  the 
vegetable,  incapable  of  fecundating  himself,  though  possessing 
two,  nearly  complete,  generative  apparatuses. 

This  is  the  complete,  or  nearly  complete,  bisexual  hermaph- 
rodite of  Geoffroy  Saint-Hilaire,  which  is  worthy  of  being 
described  with  the  cases  of  Marie-Madeleine,  of  Lefort,  and  the 
hermaphrodite  of  Schrell,  the  only  known  instances  in  the 
human  species. 

N.  P  died  a  bachelor,  but  had  he  any  predilections  for 

either  sex  ?  Had  he  ever  menstruated  ?  My  researches  in  this 
direction  are  not  yet  completed. 


HERMAPHRODISM. 


45 


We  give  this  observation  with  all  its  details  as  a 
striking  example  of  bisexual  hermaphrodism.  "  Tliese 
cases,  moreover,"  said  M.  Tardieii,  constitute  the  true 
hermaphrodism  in  which  the  individual,  possessing  the 
attributes  of  both  sexes,  is  in  a  state  entirely  incapable 
of  forming  a  valid  marriage  ;  for.  whichever  may  be  the 
sex  to  which  he  is  united,  there  will  be  between  them  an 
identity  of  sex,  that  is  to  say,  nullity  of  marriage." 


PARTICULAR  NOTICE  TO  THE  MEDICAL  PROFESSION. 

Publishers,  General  Bookseller:  and  Stationers,  and  dealers  in  Medical  and  Surgical  Publications, 
c  n  I  c     G-o  . 

W.  B.  Keen,  Cooke  &  CO.'S  stock  of  Medical  Books  is  the  most  extensive  in  the  West. 
New  and  Important  Work  on  the  3Iicroscope.    By  Dr.  Richardson,  of  Phila- 
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Of  these  two  books,  Dr.  Danforth.  Lecturer  on  Pathology  in  Rush  Medical  College,  says,  as 
follows  :  "  Dr.  Richardson's  book  was  prepared  with  special  reference  to  physicians  '  who  are  too 
busy  to  search  through  the  elaborate  and  expensive  manuals'  already  in  existence,  but  who  are 
still  desirous  of  using  the  microscope  with  some  degree  of  intelligence  and  understanding.  The 
author  takes  hold  of  his  task  in  a  straight-forward  and  business-like  manner,  and  the  result  is  a 
most  excellent  and  useful  book.  While  the  captious  critic  could  doubtless  find  food  for  fault  find- 
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been  published.  Into  the  space  of  326  octavo  pages  Dr.  Richardson  has  compressed  all  that  the 
physician  needs  to  guide  him  in  the  selection  of  a  microscope,  as  well  as  in  its  use  for  diagnostic 
purposes.  We  would  especially  commend  the  chapters  on  the  "  Examination  of  Urine  ;"  it  is 
difficult  to  see  how  a  physician  of  any  experience  at  all  in  microscopy,  could  fail  in  making  correct 
diagnoses  of  the  various  forms  of  renal  disease  after  a  careful  and  practical  study  of  the  five 
chapters  devoted  to  the  microscopy  of  the  urine. 

Another  very  excellent  and  valuable  chapter,  is  that  on  the  "Examination  of  Sputum  in 
Phthisis,  etc.,"  a  subject  of  vast  importance  in  its  relations  to  the  early  differential  diagnosis  of 
diseases  of  the  respiratory  organs. 

The  majority  of  microscopists  would  probably  speak  with  less  confidence  in  regard  to  their 
ability  to  determine  the  source  whence  dried  blood  stains  are  derived  than  does  Dr.  Richardson, 
but  it  is  none  the  less  true  that  the  author's  chapter  on  that  subject  gives  evidence  of  much  care- 
ful and  conscientious  study  on  this  point,  and  his  opinions  are  entitled  to  great  weight. 

The  chapter  on  the  '"Examination  of  Morbid  Growths,"  is  singularly  disjointed  and  incom- 
plete ;  it  is,  indeed,  the  least  valuable  chapter  in  the  book.  It  seems  especially  strange  that  a 
pathologist  of  Dr.  Richardson's  experience  should  content  himself  with  merely  reproducing  the 
venerable  old  illustrations  of  cancer  which  we  find  on  pages  312  and  313  ;  illustrations  which  have 
done  service  in  Prof.  Bennett's  book  for  j-ears  past,  and  were  based  on  a  cardinal  error  to  begin 
with.  We  notice,  also,  that  in  several  instances  the  author  attempts  to  deal  with  Prognosis" 
and  "  Treatment,"  subjects  which  have  no  more  connection  with  microscopy  than  they  have 
with  astronomy. 

In  spite  of  these  minor  defects,  however,  we  heartily  commend  this  book  as  the  Hand- 
Book  of  Medical  Microscopy"  best  fitted  for  the  physician's  office  table. 

Mr.  Phin's  little  work,  which  is  a  mere  brochure^  "intended  for  beginners,"  is  a  step  in  the 
right  direction.  It  is  a  vehicle  of  good  common  sense,  in  proof  of  which  we  quote  the  following 
from  page  44  :  "  The  proper  question"  [in  regard  to  magnifying  power,]  "  is  not,  how  much  does  a 
microscope  magnify,  but  how  much  does  it  show."  "A  magnifying  power  of  one  hundred  diam- 
eters, obtained  by  the  use  of  first  class  objectives,  will  enable  us  to  see  more  of  the  true  structure 
of  an  object  than  could  be  reached  bj'  a  magnifying  power  of  five  hundred,  the  lenses  in  the 
-latter  case  being  of  inferior  quality."  Without  attempting  an  exhaustive  review  of  this  miniature 
volume,  it  is  sufficient  to  say  that  it  contains  the  essentials  of  amateur  microscopy,  which  is  all 
the  author  claims  for  his  modest,  but  meritorious  effort.  i.  n.  d. 

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PHYSICIAN  ANO  PATIENT. 

"  Men  see  clearly,  like  owls,  in  the  night  of  their  own  notions,  but  in  experience,  as  in  daylight, 
they  wink-  and  are  but  half-sighted." — Bacon. 

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Demonstrating  the  responsibilities  of  the  Physician  to  his  patient. 

CIVIL  MALPRACTICE 

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they  have,  sustained. 

2.  Crimi.n  al  Malpractice,"  in  which  the  People,  or  State,  is  made  the  plaintitif.  1  he  preieiu 
work  is  limited  to  the  consideration  of  the  first  division  of  the  subject." 

CONTENTS.— Civit.  Malpractice.  Definition  of  term— Allegation  of  Plaintiff— Definition 
of  Ordinary  Skill — Quacks,  Definition  of — Adjudicated  Cases — The  Physician  must  adhere  to  his 
adopted  method — Medical  Books  in  Evidence — Necessity  for  making  visits — No  departure  from 
cour.-e  of  treatment  adopted — Initial  Bandage — Contributory  Negligence— Negligence  and  Skill 
from  a  Medical  Stand-point— Crepitus,  Difficulty  of  Diagnosis — Dislocations — Skill  in  Treatment 
— ^"  Setting  "  of  Fractures,  time  for  Reduction — Means  to  prevent  Shortening — Impacted  Fracture 
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Price,  SS.OC).      INlailed  Fiee. 

Published  hy 

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NERYOTJS  and  METJIATIO  AFPEOTIOIS 

TREATED  BY  STATIC  ELECTRICITY. 

By  Dr.  AllTHUIS,  a  noteil   I'ractiMoner  of   Talis,  France. 

Translated  by  J.  H.  E  1  H  F. Rl DG M.  D.,  Professor  of  General  rherapeutics  in  Rush  Medical 

College,  Chicago. 

One  volume,  i2ino.  Illustrated,  price,  .'((2.00. 

CON-a?E3SrTS   OJ^   THE    ^^OXaTJ3yI:E  :  * 


History  of  Medical  Electiiciiy. 
Inferiority  of  Dynamic  Electricity— its  Dan- 
gers. 

Static  Electricity;  Operative  Procedures. 
Electric  INIachine. 
Insulator. 
Excitators. 
Electric  Bath. 

Absorption  of  Electricity  by  the  Human 
Body. 

Electric  Currents. 

Sparks  and  Electric  Friciioii>. 

Electric  Douches  and  Pulveri/.iiions, 

Natural  Electric  Currents. 

Frictions — Shampooing 

Examination  of  the  Patient. 
On  Transport  of  Medicines  by  Static  Elec- 
tricity. 
Medicines. 

E.vperiments  of  Dr.  Buni. 
Clinical  Observations. 
Epilepsy. 

Paralysis  with  Aphasia. 
Progressive  Locomotor  Ataxia. 
Rheumatism. 


Muscular  Contractions. 

Rheumatism — General    Innervation,  Moial 

Prostration. 
Hysteria. 

Chorea,  or  St.  Vitus"  Dance. 
Neuralgias. 
Facial  Neuralgia. 
Intercostal  Neuralgia. 
Sciatica. 

Gastralgia — Nervous  Vomitiiij^s. 
Asthma — Pulmonary  Empli vscma. 
Deafness. 
Amaurosis. 

Action  of  Static  Electricity  011  Menstniatiou 

—  Dysmenorhoea. 
Chronic  Diarrhoea. 
Incontinence  of  Urine. 

Paralysis  of  the  Bladder. 
Tonic  and    Recuperating  Action  ol  static 

Electricity  upon  Enfeebled  Subjects  and 

Old  People. 
Hypochondria. 
Hectic  Fever. 
Pulmonary  Phthisis. 


We  .shall  be  pleased  to  mail  a  copy  of  ARTHUIS'  STATIC  ELECTRICITV  to  every 
Physician  in  the  United  States.    Mailed,  postage  prepaid,  on  receipt  of  $2.00.  Address,— 

H  .  «.  KEEX,  COOKE  it  CO.,  ruhlishei  s, 

Nos.  113  and  115  State  St..  Chicago. 


HE  LEADING  MEDICAL  JOURNAL 


o  :p  t 


EST. 


I  he  Chicago  M^^^i^al  Journal 

AND  EXAMINER. 

EDITOR  : 
W  I  LI  I  \M  II.  BVLORD,  A.M.,  ]\LD. 


ASSOCIATE  EDITORS 


jAMKs  II.  fthi:kiik.i 

NOKMA.V  BRinr.K,  M  ' 


JAS.  NEVINS  HYDE,  A.M.,  . M.J). 
FERD.  C.  MO'FZ,  M.D. 


TKKM> 


pjiMl.i,,  1  he  Chitago  Medical  Press  Association. 

Irssuecl  Twelve  Tjiiieft  a  Year. 


i.se  which  lin.Jly  leti  to  the  union  of  the  two  existing  Journals  was 
he  organisation  of  a  joint  stock  company,  to  be  entitled  '*  The 


Tin-  (  liiciiiro  >If<Mrjil  Jooriial  and  Kxaminer  is  an  entirely  new  Jmirnal, 

Hossessing  in  a  high  degree  respectability  and  influence,  which  have 
for  a  number  of  years,  viz. :  '  The  Chicago  Medical  Journal and 
I     .miner.'''  • 
.11   since  . I  few  niedicnJ  j;cntlemen  conceived  the  idea  of  starting  anothef  Journal 
■  ave  no  bias  toward  any  institution  or  party  ;  one  in  which  all  members  of  the 
,'  !•<•  their  energies  for  tin-  advancement  of  medical  Science, 
eiiterpris 
r  with-  tht 

'  l  os  Association,"  for  the  purpose  of  publishing  a  Medical  Journal,  and  the 
..cut  ol  a  Medical  Library- and  Reading  Rooms  for  the  benefit  of  the  members  of  the 
■  n.  . 

-.•  irii'ntion  i.*  now  complete,  the  Journals  are  united  under  the  name  of  the  ChicagjO 
•■  \L  AND  F-X.^JiiNHH,  .ind  the  Medical  Press  Association  is  responsible  for  its  editorial 
I  )nr  facilities  for  obtaining.'  foreign  and  domestic  exchanges  are  such  as  to  assure 
...  soon  be  in  receipt  of  tlif?  most  valuable  periodicals  from  the  medical  centres  of 
1  I  win  tbein  will  be  gleaned  all  new  facts  and  discoveries,  upon  their  first  appearance. 
III.'   F!xeerpt  Department  of  "  The  Medical  Journal  and  Exan.iner"  will  be  an 
'\  !' 'c-  -i  .  :  i:  !  profitableone.  ■  , 

'.!s  Hospitals  and  Societies  of  Chicago  will  appear  upon  our  pages  in 
in  a  mirror  of  the  practice  of  our  industrious  and  accomplished  corps 

lice  Irom  many  of  the  great  cities  of  this  country  and  Europe  is  promised,  ai:d 
i.int  feature. 

of  Original  Communications,  Reports  of  Societies,  Summary  of  Progress, 
Reports  of  Hospitals  apd,Private  Practice,  will  be  leading  features  of  the 
I  .\aminer.  -  . 

'  :il  Journal  and  Examiner  will  be  issued  twelve  tiipes  a  year,  on  the  first  of 
1  to  all  subscribers  in  the  . United  States, -Po.virtgre  Prepaid  by  the 

f  I'uur  Dollars.      -  ,  ' 

I'he  Chicago  Medical  Journal  and  Examiner  commences  January,  1876, 
.  npi.(  lis  -in.uld  commence  with  iliat  da;e  in  order  to  secure  the  numbers  complete  for 
vr.ir.   

lE'oxxx'  nvXoxxtlLs  030.  Tr±a,l  J 

riie  nnnil>pr8  for  September,  October,  Xovember  and  December,  1875, 
p  -t         uu  receipt  of  One  Dollar.    Try  tliese  numbers  and  you  will  be  sure  to 
I..:  year. 

lodical  Journals  published  in  the  United  State.s,  all  of  which  would  be  valu- 
Take  them  all  if  yon  are^able  to  do  so,  but  if  you  can  afford 
re  The  Chicagrt  Medical  Journal  and  Kxaminer. 


W.  B.  KEEN,  COOKE  &  CO., 

I-'viblisher'KS, 

11  a  and  l  l  .>  State  Street,  CHICA^^O. 


